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Effects of Implementing a Standardized Surveillance Program on Cardiac Neurodevelopmental Program Referral Completion

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Abstract

Differences in surveillance methods have resulted in significant variability in referral volumes and referral completion rates across cardiac neurodevelopmental programs, with frequent barriers to referral completion including high no-show rates, lack of education, and inaccessibility for underrepresented populations. The purpose of this study was to describe implementation of a standardized surveillance program and investigate impact on referral volume and completion over a two-year period. Between fiscal years 2021 and 2022, a surveillance program was implemented which standardized assessment of neurodevelopmental risk via a checklist as well as family education and referral procedures. All patients referred to the cardiac neurodevelopmental program during these two fiscal years were included in the analysis, and patient referrals were categorized as complete or incomplete (due to physician-related or patient-related factors). Referral completion rates between fiscal years were compared using two sample Z test of proportions, while associations between referral completion and demographic/anatomical variables were completed using chi-square tests of independence. Implementation of the formal surveillance program resulted in a 66.7% increase in referral volume. Proportions of both incomplete referrals (z = 2.00, p < 0.05) and incomplete referrals due to physician-related factors (z = 4.34, p < 0.01) were significantly lower after implementation. A significant association was found after implementation between referral completion and race/ethnicity (x2 = 14.08, p < 0.01) due to a significantly high proportion of completed referrals for patients identifying as Hispanic/Latino within the overall distribution of patients. This study describes the successful implementation of a standardized surveillance program, including improvements to referral volume and completion rate. Findings also support implementation of methods that emphasize physician surveillance methods and improve accessibility for historically marginalized groups at greatest risk for disparities in access and quality of care.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

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Acknowledgements

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Funding

The authors received no specific funding for this study.

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Authors and Affiliations

  1. Department of Psychology and Neuropsychology, Children’s Hospital of Orange County, 1120 West La Veta Avenue, Suite 470, Orange, CA, 92868, USA

    Heather Hennrick, Viannae Carmona Nelkin, Ana-Mercedes Flores, Dianne Kong & Alexander Tan

  2. Heart Institute, Children’s Hospital of Orange County, Orange, CA, USA

    Elizabeth Miller, Wyman W. Lai, Marissa Olson & Alexander Tan

  3. Department of Pediatrics, University of California Irvine, Irvine, CA, USA

    Wyman W. Lai

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  1. Heather Hennrick
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  2. Elizabeth Miller
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  8. Alexander Tan
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Contributions

The authors confirm contribution to the paper as follows: study conception and design: HH, EM, WWL, AT; data collection: HH, EM, VCN, MO, AT; analysis and interpretation of results: HH, AT; draft manuscript preparation: HH, EM, VCN, AF, MO, DK, AT; critical revision of article: HH, EM, VCN, AF, WWL, AT. All authors reviewed the results and approved the final version of the manuscript.

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Correspondence to Alexander Tan.

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The authors declare that they have no conflicts of interest to report regarding the present study.

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The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national guidelines on human experimentation according to the Belmont Report and with the Helsinki Declaration of 1975, as revised in 2008, and has been approved by the Institutional Review Board at Children’s Hospital of Orange County.

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Hennrick, H., Miller, E., Lai, W.W. et al. Effects of Implementing a Standardized Surveillance Program on Cardiac Neurodevelopmental Program Referral Completion. Pediatr Cardiol 45, 821–828 (2024). https://doi.org/10.1007/s00246-024-03425-9

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