title: Referral of very low birth weight infants to high-risk follow-up at neonatal intensive care unit discharge varies widely across California.
abstract: OBJECTIVE
  To determine rates and factors associated with referral to the California Children's Services high-risk infant follow-up (HRIF) program among very low birth weight (BW) infants in the California Perinatal Quality of Care Collaborative.
  
  
  METHODS
  Using multivariable logistic regression, we examined independent associations of demographic and clinical variables, neonatal intensive care unit (NICU) volume and level, and California region with HRIF referral.
  
  
  RESULTS
  In 2010-2011, 8071 very low BW infants were discharged home; 6424 (80%) were referred to HRIF. Higher odds for HRIF referral were associated with lower BW (OR 1.9, 95% CI 1.5-2.4; ≤ 750 g vs 1251-1499 g), higher NICU volume (OR 1.6, 1.2-2.1; highest vs lowest quartile), and California Children's Services Regional level (OR 3.1, 2.3-4.3, vs intermediate); and lower odds with small for gestational age (OR 0.79, 0.68-0.92), and maternal race African American (OR 0.58, 0.47-0.71) and Hispanic (OR 0.65, 0.55-0.76) vs white. There was wide variability in referral among regions (8%-98%) and NICUs (<5%-100%), which remained after risk adjustment.
  
  
  CONCLUSIONS
  There are considerable disparities in HRIF referral, some of which may indicate regional and individual NICU resource challenges and barriers. Understanding demographic and clinical factors associated with failure to refer present opportunities for targeted quality improvement initiatives.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality of Care Collaborative (CPQCC)-California Children's Services (CCS) High Risk Infant Follow-Up Quality of Care Initiative, Stanford, CA. Electronic address: srhintz@stanford.edu.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hintz
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality of Care Collaborative (CPQCC)-California Children's Services (CCS) High Risk Infant Follow-Up Quality of Care Initiative, Stanford, CA; CPQCC, Stanford, CA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Gould
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; CPQCC, Stanford, CA.
authors.forename: Mihoko V
authors.initials: MV
authors.lastname: Bennett
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality of Care Collaborative (CPQCC)-California Children's Services (CCS) High Risk Infant Follow-Up Quality of Care Initiative, Stanford, CA.
authors.forename: Erika E
authors.initials: EE
authors.lastname: Gray
authors.affiliation: California Department of Health Care Services, Children's Medical Services Branch, Sacramento, CA.
authors.forename: Kimie J
authors.initials: KJ
authors.lastname: Kagawa
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Department of Health Care Services, Children's Medical Services Branch, Sacramento, CA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schulman
authors.affiliation: CPQCC, Stanford, CA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Murphy
authors.affiliation: CPQCC, Stanford, CA.
authors.forename: Grace
authors.initials: G
authors.lastname: Villarin-Duenas
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; CPQCC, Stanford, CA.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
mesh_terms: D002140:California; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment