Delays in Obtaining Knee MRI in Pediatric Sports Medicine: Impact of Insurance Type

Beck, Jennifer J.; West, Nicole M.; Shaw, Kylie G; Jackson, Nicholas; Bowen, Richard E.

doi:10.1097/bpo.0000000000001653

Cited by 15 publications

(19 citation statements)

References 14 publications

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“…Numerous studies since then have shown that any of the following may result in delayed treatment among patients with public insurance: limited patient resources; a small number of surgeons accepting public insurance, potentially related to low Medicaid reimbursements; and a lack of appointment times. 6,14,16,24,26 Despite these consistent findings in the literature and changes to health care in the United States, children with public insurance continue to experience disparities in orthopaedic care 20 years later. Kitchen et al 17 recently analyzed the care timeline in 21 of the most common pediatric fractures, noting that delay between injury and referral is the primary reason for the late orthopaedic evaluation experienced by patients with public insurance.…”

Section: Discussionmentioning

confidence: 87%

“…Numerous studies since then have shown that any of the following may result in delayed treatment among patients with public insurance: limited patient resources; a small number of surgeons accepting public insurance, potentially related to low Medicaid reimbursements; and a lack of appointment times. 6,14,16,24,26 Despite these consistent findings in the literature and changes to health care in the United States, children with public insurance continue pediatric patients with an ACL tear are more likely to experience prolonged time from injury to presentation and from evaluation to surgery. 9,31 Ultimately, these delays in evaluation and treatment are associated with more severe concomitant meniscal and chondral pathology and inferior clinical outcomes.…”

Section: Discussionmentioning

confidence: 97%

“…The American Journal of Sports Medicine 2021;49 (14):3842-3849 DOI: 10.1177/03635465211046928 Ó 2021 The Author(s) specialized orthopaedic care often exist and may be related to socioeconomic and demographic factors, including insurance status. 6,14,16,17,24,26,28 Given the rare nature of TSFs and the limitations of the current literature, there is the potential for a resultant delay in diagnosis, referral to a subspecialist, and variations in the approach to treatment. Furthermore, as insurance status has been demonstrated to affect care after other pediatric injuries, it may similarly compound the issues that stem from the uncommon nature of TSFs.…”

mentioning

confidence: 99%

“…Unfortunately, delays and disparities in specialized orthopaedic care often exist and may be related to socioeconomic and demographic factors, including insurance status. 6,14,16,17,24,26,28…”

mentioning

confidence: 99%

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Does Insurance Status Affect Treatment of Children With Tibial Spine Fractures?

et al. 2021

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Background: Previous studies have reported disparities in orthopaedic care resulting from demographic factors, including insurance status. However, the effect of insurance on pediatric tibial spine fractures (TSFs), an uncommon but significant injury, is unknown. Purpose: To assess the effect of insurance status on the evaluation and treatment of TSFs in children and adolescents. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We performed a retrospective cohort study of TSFs treated at 10 institutions between 2000 and 2019. Demographic data were collected, as was information regarding pre-, intra-, and postoperative treatment, with attention to delays in management and differences in care. Surgical and nonsurgical fractures were included, but a separate analysis of surgical patients was performed. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: Data were collected on 434 patients (mean ± SD age, 11.7 ± 3.0 years) of which 61.1% had private (commercial) insurance. Magnetic resonance imaging (MRI) was obtained at similar rates for children with public and private insurance (41.4% vs 41.9%, respectively; P≥ .999). However, multivariate analysis revealed that those with MRI performed ≥21 days after injury were 5.3 times more likely to have public insurance (95% CI, 1.3-21.7; P = .02). Of the 434 patients included, 365 required surgery. Similar to the overall cohort, those in the surgical subgroup with MRI ≥21 days from injury were 4.8 times more likely to have public insurance (95% CI, 1.2-19.6; P = .03). Children who underwent surgery ≥21 days after injury were 2.5 times more likely to have public insurance (95% CI, 1.1-6.1; P = .04). However, there were no differences in the nature of the surgery or findings at surgery. Those who were publicly insured were 4.1 times more likely to be immobilized in a cast rather than a brace postoperatively (95% CI, 2.3-7.4; P < .001). Conclusion: Children with public insurance and a TSF were more likely to experience delays with MRI and surgical treatment than those with private insurance. However, there were no differences in the nature of the surgery or findings at surgery. Additionally, patients with public insurance were more likely to undergo postoperative casting rather than bracing.

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Section: Discussionmentioning

confidence: 87%

“…Numerous studies since then have shown that any of the following may result in delayed treatment among patients with public insurance: limited patient resources; a small number of surgeons accepting public insurance, potentially related to low Medicaid reimbursements; and a lack of appointment times. 6,14,16,24,26 Despite these consistent findings in the literature and changes to health care in the United States, children with public insurance continue pediatric patients with an ACL tear are more likely to experience prolonged time from injury to presentation and from evaluation to surgery. 9,31 Ultimately, these delays in evaluation and treatment are associated with more severe concomitant meniscal and chondral pathology and inferior clinical outcomes.…”

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Does Insurance Status Affect Treatment of Children With Tibial Spine Fractures?

et al. 2021

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“…The timing to diagnosis via MRI is also impacted for these knee injuries. Beck et al examined 168 patients who underwent knee MRI and found that the time between injury and MRI was significantly longer for government-insured patients (34 days versus 67 days) as was the time between 1st visit and MRI and MRI order and completion [41].…”

Section: Pathology-specific Disparitiesmentioning

confidence: 99%

Disparities in Youth Sports and Barriers to Participation

Pandya

2021

Curr Rev Musculoskelet Med

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Purpose of Review Youth sports participation has shifted from a school-based, seasonal activity to club-based, year-round activity over the past 10–15 years. Single sport specialization has become increasingly common with a concurrent increase in injury and burnout. Paralleling trends seen in other aspects of health care, disparities in regard to participation in youth sports, and subsequent injury treatment exist as well. Recognition of these disparities amongst coaches, parents, and athletes involved in youth sports are essential to promote the short- and long-term health of pediatric and adolescent athletes. Recent Findings Multiple barriers exist for youth in regard to sports participation. Youth who come from families without extensive financial means are increasingly finding it difficult to play organized sports, with this trend holding when broken down by insurance status (public versus private). This problem is further exacerbated by the lack of community-based programming in locations where organized (albeit expensive) options do not exist. The lack of athletic trainers increases the divide, as well as the care that injured athletes receive (particularly in public schools within communities of color) is not equivalent to schools with extensive financial resources. Thus, ability to quickly return to play after injury and/or access the health care system is limited. This is further exemplified by inferior outcomes in regard to care for anterior cruciate ligament, meniscus, shoulder instability, and concussions in this population. Summary Youth sports participation is laden with multiple disparities. This is unfortunately reflective of historical barriers to opportunities/advancements in multiple other areas of society. These disparities place certain groups of children at an uphill battle not only for participation when healthy, but also returning to participation when injured. Larger structural changes in youth sports are necessary to promote life-long, healthy physical activities for individuals most at risk.

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