title: Parent Language: A Predictor for Neurodevelopmental Follow-up Care Among Infants With Very Low Birth Weight.
abstract: Preterm/very low birth weight infants may suffer neurodevelopmental delays. Pediatricians should monitor neurodevelopment and pursue timely referrals. Yet parents who speak non-English primary languages (NEPL) report worse health care communication and fewer appropriate specialty referrals for their children. We sought to determine whether infants of NEPL parents receive recommended outpatient follow-up care for neurodevelopment. We hypothesized that these infants received less care than infants of English speakers.
  
  
  
  We linked paid claims from California Children's Services to clinical data from California Perinatal Quality Care Collaborative (58% linkage rate, 1541 subjects) for publicly insured infants with birth weight <1500 g or gestational age ≤32 weeks. Our primary outcomes were completion of 1) preventive visits and 2) ophthalmology visits; and receipt of 3) influenza vaccination and 4) palivizumab. To compare group differences, we also assessed 5) hospital length of stay and 6) readmissions. Analyses were adjusted for medical severity and sociodemographic characteristics.
  
  
  
  A total of 433 infants (28%) had NEPL parents. Infants of NEPL parents had 38% higher odds of receiving influenza vaccination (95% confidence interval 9-75, P = .008) and completed 8% more preventive visits (95% confidence interval 1-64, P = .019) than infants of English speakers. Infants of NEPL parents did not have longer lengths of stay or more readmissions.
  
  
  
  Infants of NEPL parents were more likely than infants of English speakers to receive some aspects of recommended outpatient follow-up care. Regardless of language, all infants received far lower rates of follow-up care than recommended by national guidelines. Future study should address the causes of these gaps.
authors.affiliation: Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, Calif; Division of General Pediatrics, Stanford University School of Medicine, Los Gatos, Calif. Electronic address: meneriz@stanford.edu.
authors.forename: Monica
authors.initials: M
authors.lastname: Eneriz-Wiemer
authors.affiliation: Center for Policy, Outcomes, and Prevention, Stanford University, Stanford, Calif.
authors.forename: Olga
authors.initials: O
authors.lastname: Saynina
authors.affiliation: Quantitative Services Unit, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Vandana
authors.initials: V
authors.lastname: Sundaram
authors.affiliation: Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, Calif; California Perinatal Quality Care Collaborative, Stanford, Calif.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford, Calif.
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
authors.affiliation: Division of General Pediatrics, Stanford University School of Medicine, Los Gatos, Calif; Center for Policy, Outcomes, and Prevention, Stanford University, Stanford, Calif.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Sanders
mesh_terms: D000359:Aftercare / Q000592:standards*; D000553:Ambulatory Care; D000998:Antiviral Agents / Q000627:therapeutic use*; D002140:California; D003144:Communication Barriers; D002658:Developmental Disabilities; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D007802:Language; D008297:Male; D065886:Neurodevelopmental Disorders; D009885:Ophthalmology; D000069455:Palivizumab / Q000627:therapeutic use; D010290:Parents; D000072143:Pediatricians; D017410:Practice Guidelines as Topic; D011315:Preventive Medicine; D000071836:Professional Practice Gaps; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018357:Respiratory Syncytial Virus Infections / Q000517:prevention & control*; D013038:Specialization
chemical_list: D000998:Antiviral Agents; D007252:Influenza Vaccines; D000069455:Palivizumab
keywords: health care disparities; infant, premature; infant, very low birth weight; language; minority health