Factors Associated With Early Intervention Referral and Evaluation: A Mixed Methods Analysis.
OBJECTIVE: To identify parent, child, community, and health care provider characteristics associated with early intervention (El) referral and multidisciplinary evaluation (MDE) by El. METHODS: We conducted a mixed methods secondary analysis of data from a randomized controlled trial of a developmen...
| Publicado en: | Academic Pediatrics Vol. 14; no. 3; pp. 315 - 324 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Elsevier B.V.
May/Jun2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107847823&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 107847823 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18762859 8NBK jtl: Academic Pediatrics issn: 18762859 maglogo: N pubinfo: dt: May/Jun2014 vid: 14 iid: 3 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 107847823 95872227 95872227 10.1016/j.acap.2014.01.007 107847823 ppf: 315 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Factors Associated With Early Intervention Referral and Evaluation: A Mixed Methods Analysis. aug: au: Jimenez, Manuel E. Fiks, Alexander G. Ramirez Shah, Lisa Gerdes, Marsha Ni, Amelia Y. Pati, Susmita Guevara, James P. affil: Department of Pediatrics, Leonard Davis Instiutte of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Developmental and Behavioral Pediatrics, PolicyLab: Center to Bridge Research, Practice & Policy, Children's Hospital of Philadelphia, Philadelphia sug: subj: Early Intervention Referral and Consultation Multidisciplinary Care Team Developmental Disabilities Human Academic Medical Centers Randomized Controlled Trials Multicenter Studies Odds Ratio Utilization Confidence Intervals Utilization Infant Multivariate Analysis Utilization Logistic Regression Utilization Adult Child, Preschool Child Adolescence Descriptive Statistics Utilization Male Female Funding Source Infant: 1-23 months Adult: 19-44 years Child, Preschool: 2-5 years Child: 6-12 years Adolescent: 13-18 years Male Female ab: OBJECTIVE: To identify parent, child, community, and health care provider characteristics associated with early intervention (El) referral and multidisciplinary evaluation (MDE) by El. METHODS: We conducted a mixed methods secondary analysis of data from a randomized controlled trial of a developmental screening program in 4 urban primary care practices. Children <30 months of age not currently enrolled in El and their parents were included. Using logistic regression, we tested whether parent, child, community, and health care provider characteristics were associated with El referral and MDE completion. We also conducted qualitative interviews with 9 pediatricians. Interviews were recorded, transcribed, and coded. We identified themes using modified grounded theory. RESULTS: Of 2083 participating children, 434 (21%) were identified with a developmental concern. A total of 253 children (58%) with a developmental concern were referred to El. A total of 129 children (30%) received an MDE. Failure in 2 or more domains on developmental assessments was associated with El referral (adjusted odds ratio [AOR] 3.15, 95% confidence interval [CI] 1.89-5.24) and completed MDE (AOR 2.16, 95% CI 1.19-3.93). Faxed referral to El, as opposed to just giving families a phone number to call was associated with MDE completion (AOR 2.94, 95% CI 1.48-5.84). Pediatricians reported that office processes, family preference, and whether they thought parents understood the developmental screening tool influenced the El referral process. CONCLUSIONS: In an urban setting, one third of children with a developmental concern were not referred to El, and two thirds of children with a developmental concern were not evaluated by El. Our results suggest that practice-based strategies that more closely connect the medical home with El such as electronic transmission of referrals (eg, faxing referrals) may improve completion rates of El evaluation. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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