title: Missed opportunities in the referral of high-risk infants to early intervention.
abstract: OBJECTIVE
  Using a statewide population-based data source, we describe current neonatal follow-up referral practices for high-risk infants with developmental delays throughout California.
  
  
  METHODS
  From a cohort analysis of quality improvement data from 66 neonatal follow-up programs in the California Children's Services and California Perinatal Quality Care Collaborative High-Risk Infant Follow-Up Quality of Care Initiative, 5129 high-risk infants were evaluated at the first visit between 4 and 8 months of age in neonatal follow-up. A total of 1737 high-risk infants were evaluated at the second visit between 12 and 16 months of age. We calculated referral rates in relation to developmental status (high versus low concern) based on standardized developmental testing or screening.
  
  
  RESULTS
  Among infants with low concerns (standard score >70 or passed screen) at the first visit, 6% were referred to early intervention; among infants with high concerns, 28% of infants were referred to early intervention. Even after including referrals to other (private) therapies, 34% infants with high concerns did not receive any referrals. These rates were similar for the second visit.
  
  
  CONCLUSIONS
  In spite of the specialization of neonatal follow-up programs to identify high-risk infants with developmental delays, a large proportion of potentially eligible infants were not referred to early intervention.
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, USA. bgtang@stanford.edu
authors.forename: Brian G
authors.initials: BG
authors.lastname: Tang
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Feldman
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Huffman
authors.forename: Kimie J
authors.initials: KJ
authors.lastname: Kagawa
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Gould
mesh_terms: D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D061345:Early Medical Intervention / Q000379:methods / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods / Q000639:trends*; D011159:Population Surveillance / Q000379:methods; D012017:Referral and Consultation / Q000639:trends*; D012307:Risk Factors