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Jules P. Antigua, Karen Karp, Anne K. Jensen, Lisa Erbring, Gil Binenbaum; Assessment of ROP Outpatient Follow Up Compliance Across Three Hospitals. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3149.
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Timely outpatient retinopathy of prematurity (ROP) follow up is critical for prevention of blindness in at-risk infants. We sought to assess outpatient ROP compliance across 3 Philadelphia hospitals, identify factors that influence show rates, and determine continued risk among infants lost to follow up.
Retrospective study of all infants requiring ROP exams and discharged home prior to retinal vascular maturity in 2007-09. Data collected included appointments scheduled, visit compliance, birth weight (BW), gestational age (GA), diagnosis and postmenstrual age (PMA) at last ROP exam, median family income (US Census) based on home zip code, and parent education and visit scheduling method at each hospital, designated A, B, and C.
566 infants met criteria at the 3 hospitals. All infants had outpatient ROP appointments scheduled for within 1-3 weeks of last exam, 539 (95%) with us, 27 (5%) elsewhere. Overall, 498 (92%) of 539 infants scheduled with us showed for outpatient follow-up. In multivariate regression, overall compliance was related to younger PMA (p=0.03), but not hospital, BW, GA, ROP diagnosis, weeks to appointment, or income. All hospitals required parents to sign a statement prior to discharge acknowledging ROP risk and importance of follow-up. A and B always made the appointment; C did so selectively, requiring many parents to call our office, but a ROP coordinator called those who did not. Only C consistently provided written ROP education. First-appointment show rates were 75% A, 82% B, 89% C (p=0.003). Coordinator calls, certified letters, and social work help for transportation or child services involvement increased the show rates to 88% A, 93% B, 94% (p=0.19). Considering PMA, BW, GA, ROP stage, zone, and disease course, only 9 of the 41 "no-show" infants were thought to be still at risk (8 with immature zone 2, PMA<38 wks; and 1 with St 2 Zn 2, PMA 37 wks).
Using standardized procedures, a dedicated ROP coordinator, and aggressive "no-show" follow up, it is possible to attain scheduling and show rates that are significantly higher than previous reports, with very few infants left at significant risk. Written ROP education increases compliance with the first scheduled appointment.
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