Timeliness of surgical care in children with special health care needs: delayed palate repair for publicly insured and minority children with cleft palate

Abbott, Megan; Kokorowski, Paul; Meara, John G.

doi:10.1016/j.jpedsurg.2010.10.002

Cited by 97 publications

(97 citation statements)

References 18 publications

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“…Recent research efforts have established disparities in access to surgical treatment for children with public insurance in comparison to patients with private payer status. In the analysis of 2,995 children under the age of 24 months with cleft palate, public insurance status was associated with a delay in cleft palate repair in comparison to children privately insured 20 . This finding was considered a significant predisposing risk factor for the future development of improper speech and hearing 20 .…”

Section: Discussionmentioning

confidence: 94%

“…In the analysis of 2,995 children under the age of 24 months with cleft palate, public insurance status was associated with a delay in cleft palate repair in comparison to children privately insured 20 . This finding was considered a significant predisposing risk factor for the future development of improper speech and hearing 20 . A corresponding survey study in Southern California, a state with the highest rate of public healthcare coverage, revealed that 97% of otolaryngologists would provide consultation to a child with commercial insurance while only 27% would provide the same service for children with public coverage 21 .…”

Section: Discussionmentioning

confidence: 94%

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Primary payer status is significantly associated with postoperative mortality, morbidity, and hospital resource utilization in pediatric surgical patients within the United States

Stone

LaPar

Mulloy

et al. 2013

Journal of Pediatric Surgery

101

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Purpose Current healthcare reform efforts have highlighted the potential impact of insurance status on patient outcomes. The influence of primary payer status (PPS) within the pediatric surgical patient population remains unknown. The purpose of this study was to examine risk-adjusted associations between PPS and postoperative morbidity, mortality, and resource utilization in pediatric surgical patients within the United States. Methods A weighted total of 153,333 pediatric surgical patients were evaluated using the national Kids’ Inpatient Database (2003 and 2006): appendectomy, intussusception, decortication, pyloroplasty, congenital diaphragmatic hernia repair, and colonic resection for Hirschsprung’s disease. Patients were stratified according to PPS: Medicare (n=180), Medicaid (n=51, 862), uninsured (n=12,539), and private insurance (n=88,753). Multivariable hierarchical regression modeling was utilized to evaluate risk-adjusted associations between PPS and outcomes. Results Overall median patient age was 12 years, operations were primarily non-elective (92.4%), and appendectomies accounted for the highest proportion of cases (81.3%). After adjustment for patient, hospital, and operation-related factors, PPS was independently associated with in-hospital death (p<0.0001) and postoperative complications (p<0.02), with increased risk for Medicaid and uninsured populations. Moreover, Medicaid PPS was also associated with greater adjusted lengths of stay and total hospital charges (p<0.001). Importantly, these results were dependent on operation type. Conclusions Primary payer status is associated with risk-adjusted postoperative mortality, morbidity, and resource utilization among pediatric surgical patients. Uninsured patients are at increased risk for postoperative mortality while Medicaid patients accrue greater morbidity, hospital lengths of stay, and total charges. These results highlight a complex interaction between socioeconomic and patient-related factors, and primary payer status should be considered in the preoperative risk stratification of pediatric patients.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Primary payer status is significantly associated with postoperative mortality, morbidity, and hospital resource utilization in pediatric surgical patients within the United States

Stone

LaPar

Mulloy

et al. 2013

Journal of Pediatric Surgery

101

View full text Add to dashboard Cite

show abstract

“…Cleft palate repair is generally recommended for infants born with cleft palate by 12-18 months of age [21][22][23]. In the U.S., most children with cleft palate receive surgery before 12 months of age [24]. As demonstrated by research in high-income countries, in addition to physical morbidity and the risks of infection, malnutrition and death, unrepaired cleft palate can have major negative implications for speech, hearing, self-esteem, and psychological development, which can lead to long-lasting adverse outcomes for social integration [15,16].…”

Section: Discussionmentioning

confidence: 99%

Inequitable Access to Timely Cleft Palate Surgery in Low‐ and Middle‐Income Countries

et al. 2015

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There is a strong negative correlation between national income status and delayed access to primary cleft palate surgery, indicating a high degree of inequity in access to surgery, particularly in low- and lower-middle-income countries. As the importance of surgery in global health is increasingly recognized, an equity perspective must be included in the global dialog to ensure that the world's poor have fair and equitable access to essential surgical care.

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“…We also aimed to determine whether there were differences in family functioning related to race and ethnicity, since these variables are known to be associated with differences in family functioning (Moos and Moos, 2002; McEachern and Kenny, 2002; Clay et al, 2007). Finally, we examined differences related to payer type (private versus public insurance) given that families with fewer financial resources may be differentially affected by the cleft diagnosis and its multiple associated treatments and surgeries (Abbott et al, 2011; Broder et al, 2012). …”

Section: Discussionmentioning

confidence: 99%

Parent-Reported Family Functioning among Children with Cleft Lip/Palate

Crerand

Rosenberg

Magee

et al. 2015

The Cleft Palate Craniofacial Journal

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Objective To examine family functioning related to sociodemographic and clinical characteristics in youth with cleft lip and/or palate (CL/P). Design Cross-sectional, multisite investigation. Setting Six U.S. cleft centers. Patients/Participants A diverse sample of 1200 children with CL/P and their parents. Main Outcome Measure Parents completed the Family Environment Scale (FES), which assesses three domains of family functioning: cohesion (or closeness), expressiveness (open expression of feelings), and conflict. Demographic and clinical characteristics were also assessed including race, ethnicity, type of insurance, and surgical recommendations. Results The FES scores for families seeking team evaluations for their youth with CL/P (mean age = 11.6 years) fall within the average range compared with normative samples. Families receiving surgical recommendations for their youth also had FES scores in the average range, yet families of children recommended for functional surgery reported greater cohesion, expressiveness, and less conflict compared with those recommended for aesthetic surgery (P < .05). For cohesion and expressiveness, significant main effects for race (P = .012, P < .0001, respectively) and ethnicity (P =.004, P < .0001, respectively) were found but not for their interaction. No significant differences were found on the conflict domain. Families with private insurance reported significantly greater cohesion (P < .001) and expressiveness (P < .001) than did families with public insurance. Conclusions Family functioning across domains was in the average range. However, observed differences by race, ethnicity, type of insurance, and surgical recommendation may warrant consideration in clinical management for patients and families.

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Timeliness of surgical care in children with special health care needs: delayed palate repair for publicly insured and minority children with cleft palate

Cited by 97 publications

References 18 publications

Primary payer status is significantly associated with postoperative mortality, morbidity, and hospital resource utilization in pediatric surgical patients within the United States

Primary payer status is significantly associated with postoperative mortality, morbidity, and hospital resource utilization in pediatric surgical patients within the United States

Inequitable Access to Timely Cleft Palate Surgery in Low‐ and Middle‐Income Countries

Parent-Reported Family Functioning among Children with Cleft Lip/Palate

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