Preterm Infant Attendance at Health Supervision Visits

Abstract

OBJECTIVES: To assess the adherence of premature infants with the American Academy of Pediatrics health supervision visit schedule, factors affecting adherence, and the association of adherence with preventive care. METHODS:Retrospective cohort of all infants #35 weeks' gestation, born 2005 to 2009, receiving care at a 30-site primary care network for at least 24 months (n = 1854). Adherence was defined as having a health supervision visit within each expected time period during the first 18 months of life. Logistic regression identified sociodemographic and medical factors associated with nonadherence and risk-adjusted association between nonadherence and outcomes.RESULTS: Only 43% received all expected health supervision visits. Those with Medicaid insurance (adjusted odds ratio [AOR] 0.46, 95% confidence interval [CI] 0.35-0.60), a visit without insurance (AOR 0.46, 95% CI 0.32-0.67), chronic illness (AOR 0.7, 95% CI 0.51-0.97), and black race (AOR 0.7, 95% CI 0.50-0.98) were less adherent, whereas provider continuity of care (AOR 2.89, 95% CI 1.92-4.37) and lower birth weight (AOR 1.67, 95% CI 1.02-2.73) increased adherence. Infants ,100% adherent were less likely to be up to date with immunizations and receive recommended preventive care. In nearly half of missed visit windows, no health supervision visit was scheduled.CONCLUSIONS: Fewer than half of premature infants were fully adherent with the preventive health schedule with associated gaps in health monitoring and immunization delays. These data suggest the importance of health supervision visits and the need to explore scheduling facilitators for those at risk for nonadherence. WHAT'S KNOWN ON THIS SUBJECT:Premature infants are at risk for medical and neurodevelopmental sequelae. Close monitoring is an important role for primary care providers. Premature infants have high use of health care services; however, little is known about the role of health supervision visits. WHAT THIS STUDY ADDS:This study explores the utilization and value of health supervision visits for premature infants. Fewer than half were found to be fully adherent to the health supervision visit schedule, resulting in preventive care gaps and immunization delays.

Early Childhood Vaccination Status of Preterm Infants

“…34 Consistent with this, a US study revealed that only 43% of infants born at #35 weeks' gestation received all expected health supervision visits in the first 18 months and that lack of adherence was associated with undervaccination. 47 Conversely, highrisk infants have many non-well visits, 48 during which parents and providers may defer vaccination if the child is acutely ill. 15,31 Additionally, preterm infants may have competing priorities during the visits because of their complex health care needs, leading to missed vaccination opportunities. They also may see multiple subspecialists.…”

Continuity of Care in Infancy and Early Childhood Health Outcomes

“…A detailed description of this methodology has been described previously. 11 We further categorized an admission as an ACSH using a modified list of conditions created by the Agency for Healthcare Research and Quality, which excluded adult-specific conditions. 30,31 In accordance with a previous study, we included acute respiratory tract infections (ICD-9 codes 464, 466), pneumococcal meningitis (ICD-9 code 320.1), streptococcal meningitis (ICD-9 code 320.2), and Haemophilus influenzae sepsis (ICD-9 code 038.41), because they are pertinent to young children and/or are vaccine preventable.…”

“…2 In adults, higher continuity is linked with fewer urgent health services and improved patient satisfaction and health outcomes. 3 -7 In pediatrics, studies have found an association with higher continuity and decreased emergency department (ED) visits, 8,9 ambulatory care-sensitive hospitalizations (ACSHs), 10 higher well visit adherence, 11 and improved receipt of preventive screening. 12 The Patient Protection and Affordable Care Act (PPACA) incentivizes the medical home by expanding funding to providers who qualify.…”

Care System Redesign for Preterm Children After Discharge From the NICU

“…31 These health supervision visits provide the first line of care that optimizes growth and development, yet preterm infants are at risk for not receiving all recommended preventive care. 32 There is also little research on what constitutes effective delivery of preventive care of the NICU graduate from the primary care setting. Articles focusing on primary care management have largely been published before more recent advances in NICU care such as increased use of sildenafil for persistent pulmonary hypertension of the newborn.…”