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Am J Perinatol 2023; 40(05): 546-556
DOI: 10.1055/s-0041-1729889
Original Article

Rural Residence and Factors Associated with Attendance at the Second High-Risk Infant Follow-up Clinic Visit for Very Low Birth Weight Infants in California

Martha G. Fuller 
1   Hahn School of Nursing and Health Science, University of San Diego, San Diego, California
,
Tianyao Lu
2   Department of Pediatrics, Stanford University School of Medicine, Stanford, California
3   California Perinatal Quality of Care Collaborative, Stanford, California
,
Erika E. Gray
2   Department of Pediatrics, Stanford University School of Medicine, Stanford, California
3   California Perinatal Quality of Care Collaborative, Stanford, California
,
Maria A. L. Jocson
4   Department of Health Care Services, California Children's Services, Integrated Systems of Care, Sacramento, California
,
Mary K. Barger
1   Hahn School of Nursing and Health Science, University of San Diego, San Diego, California
,
Mihoko Bennett
2   Department of Pediatrics, Stanford University School of Medicine, Stanford, California
3   California Perinatal Quality of Care Collaborative, Stanford, California
,
Henry C. Lee
2   Department of Pediatrics, Stanford University School of Medicine, Stanford, California
3   California Perinatal Quality of Care Collaborative, Stanford, California
,
Susan R. Hintz
2   Department of Pediatrics, Stanford University School of Medicine, Stanford, California
3   California Perinatal Quality of Care Collaborative, Stanford, California
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Abstract

Objective This study was aimed to determine factors associated with attendance at the second high-risk infant follow-up (HRIF) visit (V2) by 20 months of corrected age after a successful first visit (V1), and the impact of rural residence on attendance rates in a statewide population of very low birth weight (VLBW; <1,500 g) infants.

Study Design Data linked from the California Perinatal Quality of Care Collaborative (CPQCC) Neonatal Intensive Care Unit (NICU) database and CPQCC-California Children's Services (CCS) HRIF database. Multivariable logistic regression evaluated independent associations of sociodemographic, maternal, family, neonatal clinical, and individual HRIF program differences (factors) with successful V2 in VLBW infants born in 2010 to 2012.

Results Of 7,295 eligible VLBW infants, 75% (5,475) attended V2. Sociodemographic factors independently associated with nonattendance included maternal race of Black (adjusted odds ratio [aOR] = 0.61; 95% confidence interval [CI]: 0.5–0.75), public insurance (aOR = 0.79; 95% CI: 0.69–0.91), and rural residence (aOR = 0.74; 95% CI: 0.61–0.9). Factors identified at V1that were associated with V2 attendance included attending V1 within the recommended window (aOR = 2.34; 95% CI: 1.99–2.75) and early intervention enrollment (aOR = 1.39; 95% CI: 1.12–1.61). Neonatal factors associated with attendance included birth weight ≤750 g (aOR = 1.83; 95% CI: 1.48–2.5). There were significant program differences with risk-adjusted rates ranging from 43.7 to 99.7%.

Conclusion Sociodemographic disparities and HRIF program factors are associated with decreased attendance at V2 among VLBW infants. These findings highlight opportunities for quality and process improvement interventions starting in the NICU and continuing through transition to home and community to assure participation in HRIF.

Key Points

  • Only 75% of VLBW infants attended the second HRIF visit.

  • Those less likely to attend were Black or had rural residence.

  • Infants in early intervention or attending first visit within recommended ages were more likely to attend.

Keywords

neurodevelopmental - premature - disparity

Disclosure

The findings and conclusions in this article are those of the authors and do not necessarily represent the views or opinions of the California Department of Health Care Services or the California Health and Human Services Agency.




Publication History

Received: 12 December 2020

Accepted: 29 March 2021

Article published online:
27 May 2021

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