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

Abstract

Abstract Background:Differences in surveillance methods have resulted in significant variability in referral outcomes 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 outcomes over a two-year period. Methods: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, representing one cohort before implementation and one cohort after implementation. Results: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 higher 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 higher number of completed referrals compared to expected values for patients identifying as Hispanic/Latino. Conclusions:This study describes the successful implementation of a standardized surveillance program, including improvements to referral volume and outcomes, and benefits to patients/families, clinicians, and systems. Findings also support implementation of methods that improve accessibility for historically marginalized groups at greatest risk for disparities in access and quality of care.