Esther K. Chung, MD, MPH¹, Kelly F. McCollum, MPH², Irma T. Elo, MPA, PhD³, and Jennifer F. Culhane, PhD, MPH². (1) Department of Pediatrics, Thomas Jefferson Medical College/A.I. duPont Hospital for Children, Jefferson Pediatrics/duPont Children's Health Program, 833 Chestnut Street, Ste. 300, Philadelphia, PA 19107, 215-955-9460, echung@nemours.org, (2) Department of Obstetrics and Gynecology, Thomas Jefferson Medical College, 834 Chestnut Street, Suite 320, Ben Franklin House, Philadelphia, PA 19107, (3) Department of Sociology, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104

Background: Public health centers (PHCs) provide pediatric care, but some women receiving prenatal care at health centers later choose hospital-based clinics for their infants. Objectives: 1) To determine the maternal and infant sociodemographic and health characteristics associated with choosing hospital-based clinics (HBCs) for infant primary care, 2) to identify reasons why mothers receiving prenatal care at PHCs do not return to PHCs for infant primary care, and 3) to determine if care at HBCs is associated with greater use of infant preventative health measures. Design/Methods: Prospective, community-based survey of women attending Philadelphia health centers. Surveys were conducted at the first PNC visit and 3-4 months postpartum. Student's t test, nonparametric tests and chi-square analyses were performed using SPSS for Windows 11.5.1. Results: Sample consisted of 1,166 mostly single (75%), uninsured (64%), low-income (median income: $5,429/yr), young (median age: 22 yrs), African American (67%) mothers and their infants. Twenty-eight percent of women brought their infants to HBCs. Women using HBCs differed from those using non-HBCs in that they were more likely to have higher education (>high school: 23% vs. 16%, p £ 0.05) and income (median: $6,192 vs. $5,198/yr, p £ 0.05), be US-born (80% vs. 75%, p £ 0.01), and be of non-white race/ethnicity (94% vs. 87%, p £ 0.001). They were also significantly more likely to have pre-pregnancy care at a HBC, have multiple sites of PNC, and to be dissatisfied with their PNC. Reasons mothers did not return to PHCs for primary care of their infants included dissatisfaction, having an infant with medical problems, and preference for pediatric expertise and/or the birth hospital. Infants receiving care at HBCs were more likely to have special needs (15% vs. 7%, p £ 0.001); and to have been born preterm (19% vs. 12%, p £ 0.01), with low birthweight (<2500gms: 15% vs. 8%, p £ 0.001), and/or hospitalized in the neonatal intensive care unit (17% vs. 11%, p £ 0.01). Use of infant preventative health measures was not related to site of care. Multivariate analyses will be conducted and results will be available at the time of presentation. Conclusions: Women receiving PNC at health centers are more likely to turn to hospital-based clinics for care of their infants if they are dissatisfied with their PNC, and/or if they have a preterm, low birthweight, or sick infant. Primary care at HBCs when compared to non-HBCs was not associated with any difference in use of preventative health measures.

Learning Objectives:

• Assess the maternal and infant sociodemographic and health characteristics associated with choosing hospital-based clinics for infant primary care.
• Identify reasons why mothers receiving prenatal care at health centers do not return to health centers for infant primary care.
• Discuss whether or not there is an association between site of care and use of infant preventative health measures.

Keywords: Infant Health, Health Service

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.