Factors associated with early intervention referral and evaluation: a mixed methods analysis.
OBJECTIVE
To identify parent, child, community, and health care provider characteristics associated with early intervention (EI) referral and multidisciplinary evaluation (MDE) by EI.


METHODS
We conducted a mixed methods secondary analysis of data from a randomized controlled trial of a developmental screening program in 4 urban primary care practices. Children <30 months of age not currently enrolled in EI and their parents were included. Using logistic regression, we tested whether parent, child, community, and health care provider characteristics were associated with EI referral and MDE completion. We also conducted qualitative interviews with 9 pediatricians. Interviews were recorded, transcribed, and coded. We identified themes using modified grounded theory.


RESULTS
Of 2083 participating children, 434 (21%) were identified with a developmental concern. A total of 253 children (58%) with a developmental concern were referred to EI. A total of 129 children (30%) received an MDE. Failure in 2 or more domains on developmental assessments was associated with EI referral (adjusted odds ratio [AOR] 3.15, 95% confidence interval [CI] 1.89-5.24) and completed MDE (AOR 2.16, 95% CI 1.19-3.93). Faxed referral to EI, as opposed to just giving families a phone number to call was associated with MDE completion (AOR 2.94, 95% CI 1.48-5.84). Pediatricians reported that office processes, family preference, and whether they thought parents understood the developmental screening tool influenced the EI referral process.


CONCLUSIONS
In an urban setting, one third of children with a developmental concern were not referred to EI, and two thirds of children with a developmental concern were not evaluated by EI. Our results suggest that practice-based strategies that more closely connect the medical home with EI such as electronic transmission of referrals (e.g., faxing referrals) may improve completion rates of EI evaluation.
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa; PolicyLab: Center to Bridge Research, Practice, & Policy, Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: jimenezm@email.chop.edu.
Manuel E
ME
Jimenez
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab: Center to Bridge Research, Practice, & Policy, Children's Hospital of Philadelphia, Philadelphia, Pa.
Alexander G
AG
Fiks
Department of Child and Adolescent Psychiatry and Psychology, MetroHealth Medical Center, Cleveland, Ohio.
Lisa Ramirez
LR
Shah
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab: Center to Bridge Research, Practice, & Policy, Children's Hospital of Philadelphia, Philadelphia, Pa.
Marsha
M
Gerdes
Hospital for Special Surgery, New York Presbyterian Hospital-Weill Cornell, New York, NY.
Amelia Y
AY
Ni
Division of General Pediatrics, State University of New York at Stony Brook, Stony Brook, NY.
Susmita
S
Pati
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab: Center to Bridge Research, Practice, & Policy, Children's Hospital of Philadelphia, Philadelphia, Pa.
James P
JP
Guevara
D000328:Adult; D001291:Attitude of Health Personnel; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis*; D018479:Early Intervention, Educational / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D010372:Pediatrics / Q000379:methods*; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*
care coordination; developmental delay; early childhood development; early intervention