Objective Otolaryngology is considered high risk for Coronavirus Disease 2019 (COVID-19) exposure and spread. This has led to a transition to telemedicine and directly impacts patient volume, evaluation and management practices. The objective of this study is to determine the impact of COVID-19 on patient characteristics in relation to outpatient attendance, ancillary testing, medical therapy, and surgical decision making. Methods A retrospective case series at an academic medical center was performed. Outpatient appointments from October 2019 (pre-COVID) and March 16–April 10, 2020 (COVID) were analyzed. Prevalence rates and odds ratios were used to compare demographics, visit characteristics, ancillary tests, medication prescribing, and surgical decisions between telemedicine and in-person visits, before and during COVID. Results There was a decrease in scheduled visits during the COVID timeframe, for both in-person and telemedicine visits, with a comparable proportion of no-shows. There was a higher overall percentage of Hispanic/Latino patients who received care during the COVID timeframe (OR = 1.43; 95% CI = 1.07–1.90) in both groups, although primary language was not significantly associated with attendance. There were fewer ancillary tests ordered (OR = 0.54) and more medications prescribed (OR = 1.59) during COVID telemedicine visits compared with pre-COVID in-person visits. Conclusion COVID-19 has rapidly changed the use of telemedicine. Telemedicine can be used as a tool to reach patients with severe disease burden. Continued healthcare reform, expanded access to affordable care, and efficient use of resources is essential both during the current COVID-19 pandemic and beyond. Level of evidence IV.
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Objectives/Hypothesis Follow‐up care in head and neck cancers (HNC) is critical in managing patient health. However, social determinants of health (SDOH) can create difficulties in maintaining follow‐up care. The study goal is to explore how SDOH impacts maintenance of HNC follow‐up care appointments. Methods A systematic retrospective chart review of 877 HNC patients diagnosed in the past 10 years a safety‐net tertiary care hospital with systems to help reduce care disparities. Cohort groups were identified and compared against protocols for follow‐up. Data were analyzed using analysis of variance, chi‐square tests, Fisher's exact tests, two‐sample t‐tests, and simple linear regression. Results The average length of follow‐up time in months and average total number of follow‐ups over 5 years were 32.96 (34.60) and 9.24 (7.87), respectively. There was no significant difference in follow‐up care between United States (US) versus non‐US born and English versus non‐English speaking patients. Race/ethnicity, county median household income, insurance status, and county educational attainment were not associated with differences in follow‐up. However, living a greater distance from the hospital was associated with lower follow‐up length and less frequency in follow‐up (P < .0001). Conclusion While income, primary language, country of birth, race/ethnicity, insurance status, and markers of educational attainment do not appear to impact HNC follow‐up at our safety‐net, tertiary care institution, and distance from hospital remains an important contributor to disparities in care. This study shows that many barriers to care can be addressed in a model that addresses SDOH, but there are barriers that still require additional systems and resources. Laryngoscope, 132:1022–1028, 2022
Objective Cleft lip and/or palate (CLP) is the most common major congenital malformation of the head and neck. Although numerous genetic features, syndromes, nutritional deficiencies, and maternal exposures have been implicated in the etiology of CLP, the impact of prematurity on the pathogenesis remains incompletely understood. This study seeks to evaluate the associations between prematurity and the development of CLP in the United States. Study Design Cross-sectional. Setting Academic medical center. Methods The Kids’ Inpatient Database (2016) was used to identify weighted in-hospital births with diagnoses of prematurity or CLP. Demographic information was obtained. Odds ratios were used to determine associations between prematurity and CLP. Results Among patients included in our data set, 8.653% (n = 326,147) were preterm; 0.136% (n = 5115) had CLP; and 0.021% (n = 808) were preterm and had CLP. Preterm infants had 1.90 times the odds (95% CI, 1.74-2.07) of developing CLP when compared with the nonpreterm population. The binary logistic regression model accounting for possible confounding variables produced an odds ratio of 1.83 (95% CI, 1.66-2.01) for the association between prematurity and CLP. Conclusion Infants who are born preterm are more likely to have CLP than full-term infants. The current results will allow for improved risk stratification, maternal counseling, and interventions in the case of prematurity. Level of Evidence: 4.
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