Previous missed visits and independent risk of loss to follow-up in the high-risk neonatal follow-up clinic

Abstract

BackgroundNeonatal intensive care unit (NICU) patients are at high risk for developmental delays. As a result, many are seen in neonatal follow-up (NFU) clinics. Disparities in NFU follow-up rates by social determinants of health exist. AimsDetermine how the number of missed visits (composed of patient-canceled visits and no-show visits) relates to risk of loss to follow-up in the NFU clinic. Study designRetrospective cohort study at a regional specialty center in the United States. Subjects262 patients born between January 1, 2014, and December 31, 2017, who were referred to the NFU clinic. Outcome measuresLogistic binomial regression was used to model risk ratio of loss to follow-up over two years, defined as not attending a recommended follow-up visit and not informing the clinic of a reason for discontinued care. ResultsOf 262 infants, 220 patients (84 %) were seen for at least one visit and 143 (65 %) completed follow-up. Younger maternal age, maternal smoking during pregnancy, maternal drug use during pregnancy, and public insurance were all associated with missing more visits. For each additional missed visit, the risk of loss to follow-up was 1.73 times higher unadjusted (95 % CI: 1.33, 2.26) and 1.81 times higher (95 % CI: 1.36, 2.40) after adjusting for confounders. The risk ratio of loss to follow-up for no-show visits was three times higher than that for patient-canceled visits. ConclusionsEach missed visit was independently associated with higher risk of loss to follow-up from NFU clinic, even after adjusting for other risk factors.