Clinical, demographic, and socioeconomic factors associated with outpatient retinopathy of prematurity follow-up.

BACKGROUND: Following hospital discharge, infants needing continued retinopathy of prematurity (ROP) examinations are vulnerable to being lost to follow-up. Social determinants of health (SDOH) may further impede access to outpatient follow-up. The purpose of this study was to evaluate the association of clinical, demographic, and socioeconomic factors with timely first outpatient ROP follow-up. METHODS: This retrospective study reviewed all infants examined for ROP inpatient between September 17, 2013, and December 31, 2023. We included only infants requiring continued outpatient ROP examination(s) at our institution. The primary outcome was "on-time" follow-up to the first outpatient visit, defined as returning within 3 days after the recommended follow-up date. Multivariable analysis was performed. RESULTS: Of 1,424 infants examined for ROP, 532 (37.4%) required outpatient ROP examination(s) (mean birth weight, 925 g; mean gestational age, 26.9 weeks, mean postmenstrual age at last inpatient examination, 41.5 weeks). Although 525 (98.7%) infants followed up outpatient, only 432 (81.2%) had "on-time" follow-up. On multivariable analysis, not following up on-time increased with recommended follow-up >14 days versus <7 days (OR = 3.9, P = 0.004), English-language preference (OR = 3.6, P = 0.04), no treatment before hospital discharge (OR = 2.4, P = 0.01), public (ie, Medicaid) versus private insurance (OR = 1.9, P = 0.02), and higher area deprivation index (OR = 1.1, P = 0.003). CONCLUSIONS: Higher risk of delayed/missed first outpatient ROP follow-up was associated with less severe disease (ie, longer recommended follow-up intervals and no ROP treatment before discharge) and SDOH (ie, having public insurance and residence in socioeconomically disadvantaged neighborhoods). Elucidating clinical, demographic, and socioeconomic factors associated with outpatient ROP follow-up nonadherence may help inform targeted efforts for improvement.

Duke Scholars

Author Sharon Fridovich Freedman Ophthalmology

Author Sandra Sue Stinnett Biostatistics & Bioinformatics, Division of Biostatistics

Author Grace Prakalapakorn Ophthalmology