The purpose of this study was to identify racial and socioeconomic disparities in craniosynostosis evaluation and treatment, from referral to surgery. Patients diagnosed with craniosynostosis between 2012 and 2020 at a single center were identified. Chart review was used to collect demographic variables, age at referral to craniofacial care, age at diagnosis, age at surgery, and surgical technique (open versus limited incision). Multivariable linear and logistic regression models with lasso regularization assessed the independent effect of each variable. A total of 298 patients were included. Medicaid insurance was independently associated with a delay in referral of 83 days [95% confidence interval (CI) 4–161, P=0.04]. After referral, patients were diagnosed a median of 21 days later (interquartile range 7–40), though this was significantly prolonged in patients who were not White (β 23 d, 95% CI 9–38, P=0.002), had coronal synostosis (β 24 d, 95% CI 2–46, P=0.03), and had multiple suture synostosis (β 47 d, 95% CI 27–67, P<0.001). Medicaid insurance was also independently associated with diagnosis over 3 months of age (risk ratio 1.3, 95% CI 1.1–1.4, P=0.002) and undergoing surgery over 1 year of age (risk ratio 3.9, 95% CI 1.1–9.4, P=0.04). In conclusion, Medicaid insurance was associated with a 3-month delay in referral to craniofacial specialists and increased risk of diagnosis over 3 months of age, limiting surgical treatment options in this group. Patients with Medicaid also faced a 4-fold greater risk of delayed surgery, which could result in neurodevelopmental sequelae.

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Background Patient understanding of their care, supported by physician involvement and consistent communication, is key to positive health outcomes. However, patient and care team characteristics can hinder this understanding. Objective We aimed to assess inpatients’ understanding of their care and their perceived receipt of mixed messages, as well as the associated patient, care team, and hospitalization characteristics. Design We administered a 30-item survey to inpatients between February 2020 and November 2021 and incorporated other hospitalization data from patients’ health records. Participants Randomly selected inpatients at two urban academic hospitals in the USA who were (1) admitted to general medicine services and (2) on or past the third day of their hospitalization. Main Measures Outcome measures include (1) knowledge of main doctor and (2) frequency of mixed messages. Potential predictors included mean notes per day, number of consultants involved in the patient’s care, number of unit transfers, number of attending physicians, length of stay, age, sex, insurance type, and primary race. Key Results A total of 172 patients participated in our survey. Most patients were unaware of their main doctor, an issue related to more daily interactions with care team members. Twenty-three percent of patients reported receiving mixed messages at least sometimes, most often between doctors on the primary team and consulting doctors. However, the likelihood of receiving mixed messages decreased with more daily interactions with care team members. Conclusions Patients were often unaware of their main doctor, and almost a quarter perceived receiving mixed messages about their care. Future research should examine patients’ understanding of different aspects of their care, and the nature of interactions that might improve clarity around who’s in charge while simultaneously reducing the receipt of mixed messages. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08178-4.