Barriers to pediatric cochlear implantation: A parental survey

Yang, Charles; Reilly, Brian K.; Preciado, Diego

doi:10.1016/j.ijporl.2017.11.026

Cited by 19 publications

(28 citation statements)

References 9 publications

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“…Among this group of no-show patients, those caregivers who reported higher levels of completed education also reported more barriers to care, somewhat counter to our original hypothesis. In a similar study by Yang et al 15 of pediatric patients with cochlear implants, a larger percentage of privately insured patients reported barriers to care compared to publicly insured patients. The authors hypothesized that this difference could be due in part to a difference in baseline expectations, which we believe could potentially explain the observed difference in our population as well.…”

Section: Discussionmentioning

confidence: 87%

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Disparities in Access to Pediatric Otolaryngology Care During the COVID-19 Pandemic

Adigwu

Osterbauer

Hochstim

2021

Ann Otol Rhinol Laryngol

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Objective: Racial/ethnic minority pediatric otolaryngology patients experience health disparities, including barriers to accessing health care. Our hypothesis for this study is that Hispanic or economically disadvantaged patients would represent a larger percentage of missed appointments and report more barriers to receiving care during the COVID-19 pandemic. Methods: A cross-sectional survey utilizing a modified version of the Barriers to Care Questionnaire was administered via telephone to no-show patients, and median income by zip code was collected. Chi-squared, logistic regression, and Student’s t-tests were used to investigate any differences in those who did and did not keep their appointments as well as any differences in mean questionnaire scores. Results: No-show patients were more likely to be Hispanic than not (OR 2.3, 95% CI: 1.3, 3.9, P = .002) and to live in a zip code that had a median income less than 200% of the federal poverty level (OR 1.7, 95% CI: 1.2, 2.4, P = .004). Respondents with a high school degree tended to report more barriers to care compared to those with less education. Conclusion: In our study, we identified ethnic, financial, and logistic concerns that may contribute to patients failing to keep their appointments with the otolaryngology clinic. Future studies are needed to assess the efficacy of measures aimed to reduce these barriers to care such as preventive plans to assist new patients and expanding telehealth services.

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Section: Discussionmentioning

confidence: 87%

“… 8 , 12 - 14 Despite recent expansions in government subsidized insurance coverage, barriers to care can persist for pediatric otolaryngology patients, with some publicly insured pediatric patients having been shown to wait a significantly longer time before cochlear implantation than privately insured patients. 15 …”

Section: Introductionmentioning

confidence: 99%

Disparities in Access to Pediatric Otolaryngology Care During the COVID-19 Pandemic

Adigwu

Osterbauer

Hochstim

2021

Ann Otol Rhinol Laryngol

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“…The impact of insurance type on delay to surgical care has been shown for various otolaryngologic surgeries, including upper airway stimulation, 13 adenotonsillectomy, 6 auditory brainstem response testing, 14 cochlear implantation, 15 and head and neck cancer treatment, 16 with publicly insured patients demonstrating higher rates of delay. Patients in our study who were insured by Medicaid at the time of their clinic visits had 40% higher odds of rescheduling the surgery than privately insured patients.…”

Section: Discussionmentioning

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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“…However, other sub categories of the core category alongside wider established themes were supported and replicated unequivocally in the literature. This included elements such as conditions of the CI process, related to the theme "Living Context and Support", which was demonstrated as inherent to the decision making process by Yang, Reilly, and Preciado (2018), who found that barriers to paediatric CI access include "pragmatics" such as taking time off work, and ability to navigate the healthcare system, aligning with the theme "Information Needs and Sources"; reflecting that parental and personal decisions are similarly impacted by healthcare system factors.…”

Section: Discussionmentioning

confidence: 99%

What makes someone choose cochlear implantation? An exploration of factors that inform patient decision making

Dillon¹,

Pryce

2019

International Journal of Audiology

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Objective: Our objective was to understand the factors that determine whether an adult who is eligible for cochlear implantation (CI) choose to take up or not take up the implant. Design: We conducted a qualitative in-depth interview study, informed by grounded theory methods of constant comparison to build a theory to describe why and how people decide to opt for CI or not. Study sample: Our samples were patients from an audiology service in England. Results: Our results describe the key factors in weighing up risks and benefits. These are influenced by living context and support, information and social identity. We identify the key features that impact decision making for adults eligible for cochlear implants. The importance of the patient lifeworld view is discussed. Conclusions: This qualitative study provides the first in depth examination of how and why patients do and do not take up the offer of cochlear implants. It highlights the complex and iterative nature of this decision making and the individualised risks that trade off benefits of implantation.

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Barriers to pediatric cochlear implantation: A parental survey

Cited by 19 publications

References 9 publications

Disparities in Access to Pediatric Otolaryngology Care During the COVID-19 Pandemic

Disparities in Access to Pediatric Otolaryngology Care During the COVID-19 Pandemic

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

What makes someone choose cochlear implantation? An exploration of factors that inform patient decision making

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