Barriers to Rehabilitation Care in Pediatric Cochlear Implant Recipients

Noblitt, Bryce; Alfonso, Kristan; Adkins, Margaret; Bush, Matthew L.

doi:10.1097/mao.0000000000001777

Cited by 46 publications

(60 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…22 Reasons for delays in care between different races/ethnicities may include difficulty accepting the diagnosis, 23 language barriers or cultural beliefs, 24 and socioeconomic factors that impact ability to attend scheduled surgical appointments. 25,26 Policy Implications…”

Section: Race/ethnicitymentioning

confidence: 99%

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Schwartz

Shah

Wetzel

2020

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

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.

show abstract

Section: Race/ethnicitymentioning

confidence: 99%

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Schwartz

Shah

Wetzel

2020

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

show abstract

“…6 Finally, the prevalence of CI mechanical complications or device malfunctions is reportedly higher among recipients in rural areas. 2 The aim of this study is to determine whether among children with congenital SNHL, place of living and distance from a CI center influence the ages of presentation, diagnosis, hearing aid fitting, and discussion with CI committees. Secondary objectives include identification of the mean ages of suspicion of hearing loss, presentation to the hospital for audiological evaluation, hearing aid fitting, diagnosis, and discussion with CI committee, among the population in Saudi Arabia; moreover, this study aimed to study the delay before being fitted with hearing aids after establishing the diagnosis.…”

mentioning

confidence: 99%

“…However, cochlear implant (CI) intervention has provided a remarkable solution. 2 with results that vary widely among recipients. 3 Early diagnosis of severe to profound SNHL is an important step in providing CI intervention at the recommended age to avoid language delay.…”

mentioning

confidence: 99%

“… 1 Rehabilitation therapy after CI is a fundamental process for successful outcomes. 2 However, rural families again experience difficulty because of the travel distance required to attain the full benefit of speech therapy sessions after CI. 3 Thus, parents report dissatisfaction because of the shortage of speech and language therapy services provided in remote areas.…”

mentioning

confidence: 99%

“… 6 Finally, the prevalence of CI mechanical complications or device malfunctions is reportedly higher among recipients in rural areas. 2 …”

mentioning

confidence: 99%

See 2 more Smart Citations

Relationship between proximity to a cochlear implant center and early presentation in children with congenital hearing loss

Alshawi

Alrawaf

Al-Gazlan

et al. 2020

SMJ

View full text Add to dashboard Cite

Objectives: To determine whether distance from a cochlear implant (CI) center can influences the ages of presentation and intervention for CI, which thus may influence CI outcomes in Saudi Arabia. Methods: This study comprised a retrospective crosssectional analysis of 221 patients who presented to the CI committee between March 2016 and March 2018 at King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia. Through phone interviews and patients' files, age at suspicion, audiology testing, diagnosis, hearing aid fitting, and CI discussion were recorded for prelingually deaf children; additionally, demographic information were recorded. Patients were divided into 3 groups based on the distance between their place of residence and the nearest CI center (residing within 200 km, 200-500 km, and >500 km). Results: Patients living within 200 km showed the youngest mean age for all tested checkpoints; however, there were no statistically significant differences among the groups. Conclusion: In Saudi Arabia, distance from CI center does not have a significant effect on age of presentation for CI intervention.

show abstract

Identification of Potential Barriers to Timely Access to Pediatric Hearing Aids

Zhang

Links

Boss

et al. 2020

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

IMPORTANCE Despite various barriers identified to early pediatric access to cochlear implantation, barriers to timely access to pediatric hearing aids are not well characterized.OBJECTIVE To identify socioeconomic, demographic, and clinical factors that may be associated with pediatric access to hearing aids. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study included 90 patients aged 1 to 15 years who were referred for auditory brainstem response (ABR) testing and evaluation for hearing aids at a single tertiary care academic medical center from March 2004 to July 2018. Children who did not receive both ABR testing and hearing aids at the same center were excluded from analysis.MAIN OUTCOMES AND MEASURES Associations of insurance type (private vs public), race/ethnicity (white vs other), primary language (English vs other), cause of hearing loss (complex vs not complex), zip code, hearing aid manufacturer, and severity of hearing loss (in decibels) with the duration of intervals from newborn hearing screening to ABR testing, from ABR testing to ordering of hearing aids, and from ABR testing to dispensing of hearing aids. RESULTSOf the 90 patients, mean (SD) age was 5.6 (3.7) years, 56% were female, and 77 (86%) were non-Hispanic. Results of χ 2 tests indicated significant assocations existed between public insurance and race/ethnicity and between public insurance and primary language other than English. Variables associated with the interval from newborn hearing screening to ABR testing included insurance type (mean difference, 7.4 months; 95% CI, 2.6-12.2 months) and race/ethnicity (mean difference, 6.9 months; 95% CI, 2.7-11.1 months). Increased delays between birth and a child's first ABR test were associated with public insurance (mean difference, 6.0 months; 95% CI, 1.8-10.2 months) and race/ethnicity other than white (mean difference, 6.0 months; 95% CI, 2.3-9.7 months). The mean time from birth to initial ABR testing was a mean of 6 months longer for patients from non-English-speaking families than for those from English-speaking families (mean [SD] interval, 14.9 [16.3] months vs 9.0 [8.5] months), although the difference was not statistically significant. Severity of hearing loss was associated with a decrease in the interval from ABR testing to ordering of hearing aids after accounting for other potential barriers (odds ratio, 0.6; 95% CI, 0.4-0.9). Zip code and complexity of the child's medical condition did not appear to be associated with timely access to pediatric hearing aids.CONCLUSIONS AND RELEVANCE This study's findings suggest that insurance type, race/ethnicity, and primary language may be barriers associated with pediatric access to hearing aids, with the greatest difference observed in time to initial ABR testing. Clinical severity of hearing loss appeared to be associated with a significant decrease in time from ABR testing to ordering of hearing aids. Greater efforts to assist parents with ABR testing and coordination of follow-up may help improve access for other at-risk ch...

show abstract

Barriers to Rehabilitation Care in Pediatric Cochlear Implant Recipients

Cited by 46 publications

References 23 publications

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Relationship between proximity to a cochlear implant center and early presentation in children with congenital hearing loss

Identification of Potential Barriers to Timely Access to Pediatric Hearing Aids

Contact Info

Product

Resources

About