Pediatric cochlear implantation: Variation in income, race, payer, and charges across five states

Huang, Zhen; Gordish‐Dressman, Heather; Preciado, Diego; Reilly, Brian K.

doi:10.1002/lary.26686

Cited by 12 publications

(16 citation statements)

References 10 publications

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Section: Discussioncontrasting

confidence: 52%

“…Unlike what has been described in other otolaryngologic procedures, such as cochlear implantation, insurance status did not significantly impact overall decannulation or time to decannulation in dsLTR. 11,28,29 A possible explanation for this, is that the majority (92.7%) of our cohort had a tracheostomy in place prior to dsLTR. As pediatric tracheostomy is associated with high medical utilization, accounting for 1.4 billion U.S. dollars in hospitalizations in 2009, we may see less of and impact of insurance status after dsLTR.…”

Section: Discussionmentioning

confidence: 94%

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Barriers to Decannulation After Double‐Stage Laryngotracheal Reconstruction

et al. 2021

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Objectives/Hypothesis To identify any potential barriers for decannulation in children undergoing double‐staged laryngotracheal reconstruction (dsLTR) beyond the severity of disease itself. Study Design Case series with chart review. Methods We performed a retrospective chart review from 2008 to 2018 of 41 children who had undergone dsLTR as primary treatment for laryngotracheal stenosis at a stand‐alone tertiary children's hospital. We examined the effect of demographic, medical, and surgical factors on successful decannulation and time to decannulation after dsLTR. Results Of the 41 children meeting inclusion criteria who underwent dsLTR, 34 (82%) were decannulated. Age, gender, race, insurance status, medical comorbidity, and multilevel stenosis did not predict overall decannulation. Insurance status did not impact time to decannulation (P = .13, Log‐rank). Factors that increased length of time to decannulation were the use of anterior and posterior cartilage grafts (P = .001, Log‐rank), history of pulmonary disease (P = .05, Log rank), history of cardiac disease (P = .017, Log‐rank), and race/ethnicity (P = .001 Log‐rank). Conclusion In a cohort with a similar decannulation rates to previous dsLTR cohorts, we identified no demographic or medical factors that influenced overall decannulation. We did observe that pulmonary comorbidity, cardiac comorbidity, and race/ethnicity lengthens time to decannulation. Level of Evidence 4 Laryngoscope, 131:2141–2147, 2021

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 94%

Barriers to Decannulation After Double‐Stage Laryngotracheal Reconstruction

et al. 2021

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“…Concerning geography's effect on age at CI, two studies found no difference in the average age at CI between states. 24,37 However, Bush et al 2013 25 found a direct relationship of age at CI with distance to CI center in Kentucky.…”

Section: Usa: Sociological Factorsmentioning

confidence: 99%

Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review

et al. 2021

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Objectives: Pediatric cochlear implantation (CI) is a multistep process, which exposes a healthcare system's potential weaknesses in ability to deliver timely care to deaf children. The current systematic review aims to determine the sociodemographic disparities that predict pediatric CI access and use among CI candidates and recipients across the world. We hypothesize that sociodemographic factors independently influence CI access and use within a given country.Study Design: Systematic review. Methods: A qualitative systematic review of PubMed, Scopus, Web of Science, and Embase databases was conducted for studies investigating the association of sociodemographic factors such as race, income, or insurance status with measures of pediatric CI access, such as age at CI or CI rate.Results: Out of 807 unique abstracts initially retrieved, 39 papers were included in the final qualitative systematic review. Twenty-seven thousand seven hundred and fifty-one CI-candidate children (6,623 CI recipients) were studied in 14 countries, with 21 studies conducted in the United States of America, published within the years of 1993 to 2020.Conclusion: Some measures of CI access, such as age at CI and rates of CI, are consistently reported in the CI disparities literature while others such as access to rehabilitation services, willingness to undergo CI, and daily CI use are rarely measured. There are persistently reported disparities in a few key measures of CI access in a few populations, while there are some populations with a paucity of data. Future studies should delineate the nuances in the mechanisms of disparities by conducting multivariable analysis of representative sample data.

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“…Disparities in healthcare delivery in pediatric otolaryngology have been well-documented, arising from multiple factors including race, socioeconomic status, insurance status, and access to care. 1 This has been demonstrated in children with a variety of otolaryngologic conditions, such as hearing loss, 2,3 rhinosinusitis, 4,5 sleep-disordered breathing, 6,7 and otitis media. [7][8][9] Lack of timely care can lead to differences in outcomes and development.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Schwartz

Shah

Wetzel

2020

Ann Otol Rhinol Laryngol

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Objective: To investigate the role of insurance carriers and changes in insurance on rates of cancelation and rescheduling of tympanostomy tube surgery. Methods: Retrospective cohort study between January 1, 2013 and December 31, 2018 at a single tertiary care academic pediatric otolaryngology practice of pediatric patients (≤18 years) who underwent tympanostomy tube placement for any indication. Patients had to have insurance providers recorded both at clinic visit and at the time of surgery. Rates of cancelation and postponement of tympanostomy tube placement were assessed. Logistic regression was performed to determine factors associated with cancelation or postponement of surgery. Results: Of the 5080 patients, 2961 patients had Medicaid and 2012 patients had private insurance at the time of surgery. A total of 197 (3.96%) patients switched insurance between clinic appointment and date of surgery. Time to surgery was nearly 2 weeks more for those who had a change in insurance vs. those who did not (33 vs. 20 days, P < .001). Those who switched insurance were nearly twice as likely to have to reschedule surgery than those who did not (OR 1.95, CI 1.42-2.67). Patients who had Medicaid as the primary payer also had increased odds of needing to reschedule and postpone surgery (OR 1.39, 95% CI 1.17-1.63). Conclusion: Difference in insurance carrier and loss/change of insurance appear to be associated with delays in tympanostomy tube placement. Standardization of re-enrollment schedules across insurance providers or a single payer model may be useful in addressing these delays in care.

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Pediatric cochlear implantation: Variation in income, race, payer, and charges across five states

Abstract: 4. Laryngoscope, 128:954-958, 2018.

Cited by 12 publications

References 10 publications

Barriers to Decannulation After Double‐Stage Laryngotracheal Reconstruction

Barriers to Decannulation After Double‐Stage Laryngotracheal Reconstruction

Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

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