Trends in educational placement and cost-benefit considerations in children with cochlear implants
Trends in educational placement and cost-benefit considerations in children with cochlear implants
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DOI：
10.1001/archotol.125.5.499
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发表时间：
1999-05-01
影响因子：
--
通讯作者：
Niparko, JK
中科院分区：
文献类型：
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作者：
Francis, HW;Koch, ME;Niparko, JK
目的：研究人工耳蜗植入对重度听障儿童教育资源利用的影响，并确定教育成本与收益的趋势。设计：回顾性研究和成本效益分析。某学术机构的门诊儿科人工耳蜗植入计划（马里兰州巴尔的摩约翰霍普金斯大学医学院听力中心），患者或其他参与者：学龄儿童，有严重的语前听力障碍，没有其他明确定义的残疾。35名儿童与多通道人工耳蜗假体和对照组的10名儿童没有植入物从“总通信”方案在马里兰州公立学校system.Interventions：多通道人工耳蜗植入和至少1年的系统的听觉技能发展计划在听力中心，与标准的教育管理的儿童与传统的放大。课堂安置和特殊教育supportsused.Results小时数：人工耳蜗植入经验的长度和全职安置在主流教室的比率之间观察到相关性（r = 0.10; P = 0.04）。完全主流化的儿童使用的植入经验的长度和特殊教育支持的小时数之间也存在负相关性（Pearson积矩相关性= -0.10; P = 0.03）。植入经验超过2年的儿童的主流化率是年龄匹配的重度听力损失儿童的两倍或更多。他们也很少被安排在独立的教室里，接受特殊教育支助的时间也较少。基于从幼儿园到12年级的教育费用的保守估计的成本效益分析显示，人工耳蜗植入和适当的听觉（再）障碍可节省30 000至200 000美元的成本。伴随听觉（再）障碍的耳蜗植入增加了对口语声学信息的获取，从而提高了学校的主流安置率，减少了对特殊教育支助服务的依赖。由于减少使用支持服务而节省的成本表明，许多儿童的人工耳蜗植入（再）植入术具有教育成本效益。
Objectives: To study the effect of cochlear implantation on the use of educational resources by profoundly hearing-impaired children and to determine trends in educational cost vs benefit.Design: Retrospective study and cost-benefit analysis.Setting: Outpatient pediatric cochlear implant program in an academic institution (The Listening Center at Johns Hopkins University School of Medicine, Baltimore, Md), in collaboration with public schools in Mary land and surrounding states.Patients or Other Participants: School-aged children with profound prelingual hearing impairment without other clearly defined disabilities. Thirty-five children with multiple-channel cochlear prostheses and a comparison group of 10 children without implants from "total communication" programs in the Maryland public school system.Interventions: Multiple-channel cochlear implantation and at least 1 year of a systematic auditory skill development program at the Listening Center, compared with standard educational management of children with conventional amplification.Main Outcome Measures: Classroom placement and number of hours of special educational support used.Results: A correlation was observed between the length of cochlear implant experience and the rate of full-time placement in mainstream classrooms (r = 0.10; P = .04). There was also a negative correlation between the length of implant experience and the number of hours of special educational support used by fully mainstreamed children (Pearson product moment correlation = -0.10; P = .03). Children with greater than 2 years of implant experience were mainstreamed at twice the rate or more of age-matched children with profound hearing loss who did not have implants. hey were also placed less frequently in self-contained classrooms and used fewer hours of special education support. A cost-benefit analysis based on conservative estimates of educational expenses from kindergarten to 12th grade shows a cost savings of cochlear implantation and appropriate auditory (re)habilitation that ranges from $30 000 to $200 000.Conclusions: Cochlear implantation accompanied by aural (re)habilitation increases access to acoustic information of spoken language, leading to higher rates of mainstream placement in schools and lower dependence on special education support services. The cost savings that results from a decrease in the use of support services indicates an educational cost benefit of cochlear implant (re)habilitation for many children.