FEB 20, 2013
The authors examined retinopathy of prematurity (ROP) follow-up care for preterm very low birth-weight (VLBW; <1500 g) infants by conducting focus groups and interviews with 47 parents of VLBW infants and interviews with 28 neonatal intensive care unit and ophthalmic providers.
They found that respondents perceived that legal liability and low reimbursement contributed to shortages of ROP providers. Some neonatal ICUs offered subsidies to attract ophthalmic providers or delayed transfers to institutions that could not provide ROP examinations and/or treatment. Sites used variable practices for coordinating ROP care.
Even at sites with a tracking database and a dedicated ROP coordinator, significant time was required to ensure that examinations and treatment occurred as scheduled. Parents' ability to manage their children's health care was limited by parental understanding of ROP, feeling overwhelmed by the infant's care, and unmet needs for resources to address social stressors.
Based on the results, the authors recommend that hospitals and ophthalmology practices share responsibility for ensuring coordinated ROP care to mitigate liability concerns. To promote integrated care, reimbursement for ROP care should be bundled to include screening, diagnosis, treatment and appropriate follow-up. Clinical information systems should be enhanced to increase efficiency and limit lapses in care. Self-management tools and connections to community resources could help promote families' attendance of follow-up appointments.Other specific approaches recommended by the authors include:
- Subsidization or offering of supplemental malpractice insurance to ROP providers by hospitals.
- Offering ophthalmic follow-up services in a multispecialty clinic for VLBW children to decrease the burden on families traveling to multiple appointments and to promote communication between health care providers.
- In neonatal intensive care units, integrating guidelines for ROP screening and treatment into a codified decision tree to help staff monitor each child's care.