Population-based assessments of ophthalmologic and audiologic follow-up in children with very low birth weight enrolled in Medicaid: a quality-of-care study.
OBJECTIVE
The purpose of our work was to determine whether children with very low birth weight (< 1500 g) who are at high risk for vision and hearing problems and enrolled in Medicaid receive recommended follow-up vision and hearing services and to examine predictors of services.


METHODS
We conducted a retrospective analysis of 2182 children born in South Carolina from 1996 to 1998 with birth weights of 401 to 1499 g, gestations of > or = 24 weeks, and survival of > or = 90 days of life. Receipt of services for Medicaid-enrolled children was assessed by using a linked data set that included files from vital records, death certificates, Medicaid, Chronic Rehabilitative Services, and the Early Intervention Program. We assessed the receipt of hearing rehabilitation by 6 months of age for children with nonconductive hearing loss and routine ophthalmologic examination between ages of 1 and 2 years for all children with very low birth weight. Multivariate logistic regression was restricted to ophthalmologic examinations because of sample size.


RESULTS
Among children with very low birth weight with nonconductive hearing loss, 20% received hearing rehabilitation by 6 months of age. Twenty-three percent of children with very low birth weight received an ophthalmologic examination between the ages of 1 and 2 years. Limiting our analysis to children < 1000 g or extending the measurement period to 7 months (hearing) and age 3 years (vision) did not substantially increase the percentage of children receiving the services. The receipt of an ophthalmologic examination was associated positively with Medicaid enrollment by the time of hospital discharge and birth in a level-3 hospital and negatively associated with higher birth weight, an Apgar score of > or = 7, and black maternal race. Among children born at < 1000 g, all of whom were eligible for the Early Intervention Program, the receipt of an ophthalmologic examination was positively associated with program enrollment.


CONCLUSIONS
There is a shortfall in the provision of critical services for children with very low birth weight. These findings reinforce the Institute of Medicine's concerns regarding inadequate outcome data and health care services for preterm infants and support the importance of enrollment in the Early Intervention Program for children with very low birth weight.
Wang
C Jason
CJ
Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts 02118, USA. jason.wang@bmc.org
Elliott
Marc N
MN
McGlynn
Elizabeth A
EA
Brook
Robert H
RH
Schuster
Mark A
MA
D002662:Child Health Services / Q000592:standards / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000175:diagnosis / Q000534:rehabilitation*; D006320:Hearing Tests / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008484:Medicaid; D015999:Multivariate Analysis; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012178:Retinopathy of Prematurity / Q000534:rehabilitation; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis*