title: Pediatrician practices regarding referral to early intervention services: is an established diagnosis important?
abstract: OBJECTIVE
  Early intervention (EI) programs provide services to children with developmental conditions, regardless of whether such children have an underlying medical diagnosis. We aim to (1) Determine the proportion of general pediatricians who believe an established diagnosis is important when considering EI referral; and (2) Determine whether this perception is associated with lower reported likelihood of referral.
  
  
  METHODS
  Mailed survey to random sample of pediatricians. We used multivariable logistic regression to study the association between the perception that a medical diagnosis is important when referring to EI, and the reported likelihood of EI referral for children with common developmental conditions.
  
  
  RESULTS
  Response rate was 55% (894 of 1617). A total of 64% of respondents considered an established diagnosis important for EI referral. Likelihood of referral for delayed speech was lower among those who considered a diagnosis important than among those who did not (77% vs 87%; P = .02). Similar patterns held for global delay (91% vs 97%; P = .02), loss of developmental milestones (80% vs 88%; P = .03), and parental concern for inappropriate development (45% vs 60%; P = .002). In multivariable models, perception of the importance of an established diagnosis was associated with lower likelihood of referral for children with delayed speech (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI] 0.26-0.87) and for parental concern for inappropriate development (aOR 0.46; 95% CI 0.30-0.72).
  
  
  CONCLUSIONS
  A majority of general pediatricians believe that an established diagnosis is important when considering EI referral. This perception is associated with decreased reported referral for children with speech delay and those whose parents express concern for inappropriate development.
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, MA 02118, USA. michael.silverstein@bmc.org
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
authors.forename: Nina
authors.initials: N
authors.lastname: Sand
authors.forename: Frances P
authors.initials: FP
authors.lastname: Glascoe
authors.forename: Vidya B
authors.initials: VB
authors.lastname: Gupta
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Tonniges
authors.forename: Karen G
authors.initials: KG
authors.lastname: O'Connor
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003695:Delivery of Health Care; D002658:Developmental Disabilities / Q000175:diagnosis*; D019988:Children with Disabilities; D018479:Early Intervention, Educational; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000639:trends; D015999:Multivariate Analysis; D016017:Odds Ratio; D010372:Pediatrics / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States