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Published on: February 12, 2018
A MULTICENTER STUDY OF RETINOPATHY OF PREMATURITY FOLLOW-UP ADHERENCE
Fahim Mahmud1, Reem Karmouta1, Jason C Strawbridge1
1Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA.
Insights
High follow-up to complete retinal vascularization was observed in infants with retinopathy of prematurity. However, pediatric ophthalmology follow-up was lower, particularly for those with public insurance at academic centers, highlighting healthcare disparities.
Area of Science:
- Ophthalmology
- Neonatology
- Health Services Research
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Timely follow-up care is crucial for monitoring ROP progression and ensuring adequate treatment to prevent vision loss.
- Socioeconomic factors and healthcare system characteristics may influence the continuity of care for these vulnerable infants.
Purpose of the Study:
- To investigate clinical and socioeconomic factors affecting follow-up to complete retinal vascularization in neonates with ROP.
- To assess the rate of adequate pediatric ophthalmology follow-up in this population.
- To identify disparities in follow-up care based on insurance status and hospital type.
Main Methods:
- A retrospective review of medical records for 402 neonates diagnosed with ROP was conducted.
- Data were collected from neonatal intensive care units at academic medical centers and a safety-net county hospital.
- Primary outcomes included rates of follow-up to complete retinal vascularization and adequate pediatric ophthalmology follow-up; secondary outcome was nonretinal ocular comorbidity.
Main Results:
- Overall, 93.6% of neonates achieved complete retinal vascularization, but only 53.5% had adequate pediatric ophthalmology follow-up.
- Public insurance was linked to significantly lower rates of pediatric ophthalmology follow-up (OR 0.66, P=0.04).
- Infants at academic centers had poorer follow-up rates compared to the safety-net hospital, especially those with public insurance (36.5% vs. 63.8%, P<0.001).
Conclusions:
- While retinal vascularization follow-up is generally high, pediatric ophthalmology follow-up rates are suboptimal.
- Insurance status and hospital type are significant risk factors for loss to follow-up in ROP infants.
- These findings underscore the need for further research into healthcare disparities affecting ROP management.
Purpose:
Characterize clinical and socioeconomic factors that impact follow-up to complete retinal vascularization and subsequent pediatric ophthalmology follow-up in neonates with retinopathy of prematurity.
Methods:
Medical records of 402 neonates diagnosed with retinopathy of prematurity from neonatal intensive care units at the University of California, Los Angeles Mattel Children's Hospital and the University of California, Los Angeles Santa Monica Hospital, both academic medical centers, and the Harbor-University of California, Los Angeles Medical Center, a safety-net county hospital, were reviewed. Primary study outcomes were the rate of follow-up to complete retinal vascularization and adequate pediatric ophthalmology follow-up. Secondary outcome was the rate of nonretinal ocular comorbidity.
Results:
In whole-cohort analysis, 93.6% of neonates were followed to complete retinal vascularization, and 53.5% had adequate pediatric ophthalmology follow-up. Public insurance was associated with lower rates of pediatric ophthalmology follow-up (Odds ratio 0.66, 95% confidence interval 0.45-0.98, P = 0.04). Participants screened at the academic medical center had lower rates of pediatric ophthalmology follow-up compared with the safety-net county hospital (50.7% vs. 63.5%, P = 0.034). In subgroup analysis, academic medical center participants with public insurance were less likely to have pediatric ophthalmology follow-up than safety-net county hospital participants with public insurance (36.5% vs. 63.8%, P < 0.001) or those with private insurance at the academic medical center (36.5% vs. 59.2%, P< 0.001).
Conclusion:
This study identified high follow-up rates to complete retinal vascularization, lower pediatric ophthalmology follow-up rates, and nonretinal ocular comorbidity at all hospitals. Insurance status relative to hospital type was identified as a risk factor for loss to follow-up. This demonstrates a need to further study health care disparities in retinopathy of prematurity infants.
