411 - The Impact of COVID-19 on Early Intervention Referral and Time to Evaluation in a Community Pediatrics Practice in New York City

Early Intervention (EI) provides services for children under age 3 with developmental delays or disabilities. Prior studies have shown that EI can improve developmental outcomes, however rates of referral to EI and time to evaluation are variable. COVID-19 presented further challenges in access to EI, the full impact of which is not well known.

Objective: To assess the impact of the COVID-19 pandemic on time from referral to evaluation for EI services.

Design/Methods: We conducted a retrospective chart review of all patients referred to EI for speech delay or autism from the Mount Sinai Pediatric Associates Practice, a community practice that primarily serves an under-resourced population. Phone calls were placed to collect information not available in the electronic medical record. Student’s t-test or Wilcoxon rank-sum test was used to compare continuous variables and chi-squared test or Fisher exact test was used for categorical variables as appropriate. Continuous variables are presented as medians (range), and categorical variables are presented as proportions. We conducted a multiple linear regression model using time to evaluation as the outcome with variables Pre/Post-COVID (defined as on or after March 2020), 2-group age (cut-off using median=1.95), sex, race, language, borough, reason for referral and insurance.

Results: 935 total referrals were made to EI between January 2017 and December 2021, 541 of which were for speech delay or autism. 209 of these patients received an evaluation after initial referral and were included in our analysis. Patients were excluded if they did not receive an evaluation or received an evaluation after subsequent referrals. 91% of patients were insured with Medicaid. 76% of patients identified English as their primary language. 71% of patients were male. The median age at time of referral was 1.95 years. Pre-COVID median time to evaluation was 31 days with a range of 7 to 205 days while post-COVID median time to evaluation was 48 days with a range of 7 to 401 days. Using multiple linear regression, we found that compared with the Pre-COVID group, time to evaluation increased 20.41 days on average in the post-COVID group, (p=0.004.)

Conclusion(s):

Our study revealed that COVID-19 significantly impacted timely access to EI evaluation in one community pediatric practice. This could result in further delays accessing needed therapies and adversely affect the developmental outcomes of children served. A deeper understanding of the factors contributing to delays in EI evaluation is critical to ensuring timely access to services for children with developmental concerns.