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Using Linked Data to Assess Patterns of Early Intervention (EI) Referral among Very Low Birth Weight Infants

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Abstract

Objectives

Access to Early Intervention (EI) services may improve cognitive and behavioral outcomes in very low birth weight infants, but few states have population-based data to evaluate EI outreach efforts. We analyzed Massachusetts (MA) infants born weighing <1,200 g to identify maternal and birth characteristics that predicted EI referral and timing of referral.

Methods

MA birth and hospital discharge records (Jan. 1998–Sept. 2000) were linked to EI referral records (Jan. 1998–Sept. 2003) via probabilistic and deterministic methods (88% linkage). Timing of EI referral among infants weighing <1,200 g was examined by infant and maternal characteristics using categorical (0–12 months, 12–36 months, or no referral) time comparisons in the crude analysis. Survival functions calculating median time to referral, and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were calculated for continuous time comparisons of EI referral from birth to 36 months.

Results

Of 1,233 infants weighing <1,200 g, 93.2% were referred to EI. After risk adjustment, referral was more likely among multiple-birth infants (HR = 1.17, 95%CI 1.06–1.30) and less likely among infants <28 weeks (HR = 0.70; 95%CI 0.64–0.77) or with low Apgar scores (<5 at 5 min; HR = 0.75; 95%CI 0.62–0.92). EI referrals were lower for infants of black non-Hispanic mothers, and mothers without private insurance (HR = 0.85; 95%CI 0.74–0.98 and HR = 0.77; 95%CI 0.68–0.86, respectively).

Conclusions

In MA, most infants born <1,200 g are referred to EI, but disparities exist. Analysis of linked population-based health and developmental services can inform programs in order to reduce disparities and improve access for all high-risk infants.

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Acknowledgements

The PELL data system is supported by the Centers for Disease Control grants # S1887-21/23 and S3485-23/23. Additional funding for Early Intervention program evaluation was provided by US Department of Education Early Intervention grant # 45139021. Presented in part at the Pediatric Academic Societies and American Academy of Pediatrics Joint Meeting, May 8, 2004, San Francisco, California and Maternal Child Health Epidemiology Conference, December 9, 2004, Atlanta, Georgia.

We thank Sally Fogerty, Howard Cabral, Jane Lazar, Ron Benham, and the MA EI program staff for their helpful comments in the preparation of this manuscript.

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Author notes

  1. Wanda D. Barfield

    Present address: Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway N.E., MS-K-22, Atlanta, GA, 30341, USA

Authors and Affiliations

  1. Massachusetts Department of Public Health, Center for Community Health, 250 Washington Street, 5th floor, Boston, MA, 02138, USA

    Wanda D. Barfield, Karen M. Clements & Nancy Wilber

  2. Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, P.O. Box 250917, Charleston, SC, 29424, USA

    Kimberly G. Lee

  3. Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA, 02118, USA

    Milton Kotelchuck

  4. Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA, 94505, USA

    Paul H. Wise

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Correspondence to Wanda D. Barfield.

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Barfield, W.D., Clements, K.M., Lee, K.G. et al. Using Linked Data to Assess Patterns of Early Intervention (EI) Referral among Very Low Birth Weight Infants. Matern Child Health J 12, 24–33 (2008). https://doi.org/10.1007/s10995-007-0227-y

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