Pediatrician Practices Regarding Referral to Early Intervention Programs: is an Established Diagnosis Important?

M Silverstein ¹, N Sand ², FP Glascoe ³, T Tonniges ⁴, B Gupta ⁵ and K O?Connor ⁴. (Sponsored by Colin M Sox)¹, University of Washington, Seattle, WA; ², The Children?s Hospital, Boston, MA; ³, Vanderbilt University, Nashville, TN; ⁴, American Academy of Pediatrics, Elk Grove, IL and ⁵, New York University, New York, NY.

 

Background: State Early Intervention (EI) programs provide free evaluation and therapeutic services to children with developmental conditions, regardless of whether such children have an established medical diagnosis underlying their developmental problem.

 

Objective: (1) To determine the prevalence among general pediatricians of the misperception that a definitive diagnosis is important when deciding whether or not to refer a child to EI services; (2) to determine whether this misperception is associated with a lower self-reported likelihood to refer to EI.

 

Design/Methods: National random sample, mailed Periodic Survey of 1626 American Academy of Pediatrics members, 2002. Only pediatricians who practiced health supervision and spent >10% of their time in general pediatrics were included in the analysis. We used multivariable logistic regression to study the association between the perception that a definitive diagnosis is important when referring a child to EI, and the self-reported likelihood of referring to EI children with a variety of common developmental conditions.

 

Results: Response rate=55%; 646 subjects were analyzed. 64% of those included in the analysis considered an established medical diagnosis important when deciding whether or not to refer a child to EI. Intent to refer to EI children with speech or language delay was significantly less likely among those who considered a medical diagnosis important than among those who did not (77% vs. 87%; p=0.02). A similar pattern held for intent to refer children whose parents express concern for inappropriate development (45% vs. 60%; p=0.003). In a multivariable logistic regression model, the misperception of the importance of an established medical diagnosis was associated with a significantly lower likelihood of EI referral for children with delayed speech or language (adjusted odds ratio [aOR] 0.48; 95% CI 0.26, 0.87) as well as for for those whose parents express concern for inappropriate development (aOR 0.46; 95% CI 0.30, 0.72).

 

Conclusions: A majority of pediatricians practicing general pediatrics believe that an established medical diagnosis is important for EI referral. Our findings suggest that this misperception may contribute to suboptimal EI referral rates among general pediatricians.