716 - Investigating inequities in vision screening for four-year-olds across primary care clinics

Publication Number: 716.5240

Cheyney Dobson, University of Michigan Medical School, Ann Arbor, MI, United States; Harlan McCaffery, University of Michigan Medical School, Ann Arbor, MI, United States; Corinne Davis, University of Michigan Medical School, Dexter, MI, United States; Julie McCormick, University of Michigan, Ann Arbor, MI, United States; Ashley Garrity, University of Michigan Medical School, Ann Arbor, MI, United States; Daniel J. Stanish, University of Michigan Medical School, Ann Arbor, MI, United States; Gary Freed, University of Michigan, Ann arbor, MI, United States

Background: Visual impairment is the most common cause of disability in children. Early detection is critical for increasing the likelihood of successful treatment and promoting positive outcomes, including academic performance. Given its importance, the American Academy of Pediatrics (AAP) recommends screening children’s vision at pediatric primary care visits, but actual rates of screening across different populations, and across different specialties are not well-known.

Objective: To examine whether 4-year-old pediatric patients seen for a well-child visit received vision screening

Design/Methods: This retrospective study was conducted in a single health system across 18 primary care clinics. Exposure variables included: gender, Area Deprivation Index (ADI) as a socioeconomic status indicator, race (Black, Other, or White), and ethnicity (Hispanic and non-Hispanic). Additional analyses investigated the association of specialty and clinical site on vision screening rates.

Results: From July 1, 2017 – June 30, 2023, 18,176 4-year-olds were seen for annual well child visits. Rates of screening varied by race and ethnicity. White patients had higher rates of screening (81.5%) compared to both Black (71.0%) and Other patients (76.0%) (p < 0.001); Non-Hispanic patients had higher rates of screening (79.5%) compared to Hispanic patients (73.3%) (p < 0.001). Gender and ADI analyses did not demonstrate clinically meaningful differences between groups. Overall screening rates varied by clinic specialty: 85.4% for General Pediatrics (GP); 57.3% for Internal Medicine & Pediatrics (MP); and 45.8% for Family Medicine (FM) (p < 0.001). However, the largest racial difference in screening within clinic specialty was identified in GP clinics with 77.7% of Black patients and 87.4% of White patients screened (p < 0.001). Across the individual 18 clinics, overall screening rates varied from 27% to 95% (p < 0.001). When controlling for clinical site, race differences were no longer significant (p= 0.393) indicating Black children were more likely to be seen in the lower performing clinics.

Conclusion(s): Vision screening rates varied by race, ethnicity and provider specialty. Lower rates of screening were seen in FM and MP clinics and the pediatric clinic that provided care to the majority of Black children. To improve rates of screening among Black and Hispanic children and promote the wellbeing of all children, health systems should ensure all primary care clinics provide vision screening in accordance with the AAP recommendations.