Date of Award

January 2022

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Veronika Shabanova

Abstract

Background: Very premature infants who survive to discharge from the neonatal intensive care unit (NICU) are faced with complex health care needs which can lead to chronic conditions and delays in neurodevelopment (Saigal and Doyle, 2008). This population has also been shown to have poor adherence to neonatal follow up program appointments, putting them at risk for delayed diagnosis and treatment (Ballantyne et al., 2012; Brachio et al., 2020). A focused description of outpatient specialty care and specialty appointment adherence had yet to be completed for a United States (US) cohort. Objectives: To determine the burden of outpatient specialty care for very preterm infants (born  32 weeks) within the first six months from initial NICU discharge, and to identify infant, maternal, and sociodemographic factors associated with appointment adherence. Methods: This is a single-center retrospective study of very preterm infants (n = 150) born between July 1, 2017 and June 30, 2019, who were discharged home prior to 52 weeks’ corrected gestational age. Medical records were used to assess specialty appointments and characteristics of infants, mothers and sociodemographic factors. Poisson modeling was used to identify variables associated with the risk of missing a specialty appointment. Results: Our population had 1,182 appointments scheduled for a total of 20 different specialists over the six months from discharge. Infants had a median of 6 [Interquartile Range (IQR) 3 – 11] scheduled appointments, with a median of 3 (IQR 2 – 4) types of specialists. Missed appointments accounted for 25.8% of all scheduled appointments. In the adjusted model, the risk of missing an appointment was higher for males (Risk Ratio (RR) 1.29 [95% Confidence Interval (CI) 1.00, 1.66], p = 0.05) and infants with federally funded insurance (RR 1.33 [95% CI 1.04, 1.70], p = 0.03). Conclusions: There is a substantial and diverse medical burden of outpatient specialty care for this very preterm population. High rates of missed appointments, with associated risk factors including male sex and having federally funded insurance, indicate an opportunity to improve adherence rates and access to medical care for these infants.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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