Abstract
Purpose :
Retinopathy of Prematurity (ROP) is a disease associated with long term visual impairment and requires follow-up until complete retinal vascularization and subsequent pediatric ophthalmology follow-up. Elucidating factors that affect follow-up adherence can inform solutions to remove barriers to outpatient care. We performed a retrospective cohort study to compare how socioeconomic and clinical factors affect ROP follow-up adherence among infants screened at a tertiary care academic medical center (AMC) and a Safety-Net County Hospital (SNCH).
Methods :
This multi-center study compared neonatal intensive care units (NICUs) at UCLA Mattel Children’s Hospital and UCLA Santa Monica Hospital (AMC) and Harbor-UCLA Medical Center (SNCH). Eligible participants included neonates who were screened for ROP during NICU admission between 2013 and 2020 with subsequent follow-up at an AMC- or SNCH-affiliated facility. Primary study outcomes were rate of follow-up to complete retinal vascularization and rate of adequate pediatric ophthalmology follow-up.
Results :
378 of 402 (94.0%) participants were followed to complete retinal vascularization. There were no significant differences in rate of follow-up to complete retinal vascularization between infants screened at the AMC vs. SNCH (p = 0.894). There were no significant socioeconomic or clinical predictors associated with follow-up to complete retinal vascularization.
216 of 402 (53.7%) participants had adequate pediatric ophthalmology follow-up. Public insurance status was associated with lower rates of pediatric ophthalmology follow up (OR=0.66, 95% CI=0.45-0.98, p = 0.04). Neonates screened at the AMC had lower rates of adequate pediatric ophthalmology follow-up compared to the SNCH (50.7% vs. 63.5%, p = 0.034). In subgroup analysis stratified by screening hospital and insurance type, SNCH participants with public insurance were more likely to have adequate pediatric ophthalmology follow-up than AMC participants with public insurance (OR=3.07, 95% CI=1.74-5.41, p = 0.0001).
Conclusions :
We found an overall lack of adequate pediatric ophthalmology follow-up, most notably in patients with public health insurance at the AMC. We propose that increased funding and research to advance SNCHs is justified given their demonstrated improved efficacy in ensuring adherence for their entire patient population.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.