Lack of Financial Barriers to Pediatric Cochlear Implantation Impact of Socioeconomic Status on Access and Outcomes
Lack of Financial Barriers to Pediatric Cochlear Implantation Impact of Socioeconomic Status on Access and Outcomes
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DOI：
10.1001/archoto.2010.90
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发表时间：
2010-07-01
影响因子：
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通讯作者：
Megerian, Cliff A.
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文献类型：
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作者：
Chang, David T.;Ko, Alvin B.;Megerian, Cliff A.
目的：(1)分析在医疗补助报销充足的环境下，社会经济地位对人工耳蜗植入的影响。(2)确定社会经济地位对单侧人工耳蜗植入后预后的影响。设计：回顾性队列研究。地点：俄亥俄州克利夫兰大学医院病例医疗中心和彩虹婴儿儿童医院（三级转诊中心）。参与者：1996年至2008年期间接受单侧人工耳蜗植入的儿科患者（年龄范围，新生儿至18岁）。主要观察指标：转介到人工耳蜗植入中心后是否接受人工耳蜗植入，术后并发症，随访预约的依从性，以及是否接受顺序双侧人工耳蜗植入。结果：本研究共纳入133例儿科患者；64名是医疗补助患者，69名是私人保险患者。两组患者首次人工耳蜗植入的几率、转诊年龄、人工耳蜗植入年龄均无统计学差异。语前医疗保险患者接受序贯双侧人工耳蜗植入术的几率小于私营保险组的一半（优势比[OR]， 0.43； P=.03）。医疗补助儿童发生并发症的几率几乎是私人保险儿童的5倍（OR, 4.6； P=.03）。51名医疗保险患者（19.6%）有10个并发症，而61名私人保险患者（4.9%）有3个并发症。与私人保险患者相比，医疗保险患者总体上错过了更多的随访预约（35%对23%）和更多的连续就诊（1.9对1.1）。结论：在医疗补助报销充足的环境中，无论社会经济背景如何，符合条件的儿童都有平等的机会接受人工耳蜗植入。然而，较低的社会经济背景与较高的术后并发症发生率、较差的随访依从性和较低的序贯双侧植入率相关。这些发现为人工耳蜗植入中心提供了机会，以创建解决此类下游差异的方案。
Objectives: (1) To analyze if socioeconomic status influences access to cochlear implantation in an environment with adequate Medicaid reimbursement. (2) To determine the impact of socioeconomic status on outcomes after unilateral cochlear implantation.Design: Retrospective cohort study.Setting: University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital (tertiary referral center), Cleveland, Ohio.Participants: Pediatric patients (age range, newborn to 18 years) who received unilateral cochlear implantation during the period 1996 to 2008.Main Outcome Measures: Access to cochlear implantation after referral to a cochlear implant center, postoperative complications, compliance with follow-up appointments, and access to sequential bilateral cochlear implantation.Results: A total of 133 pediatric patients were included in this study; 64 were Medicaid-insured patients and 69 were privately insured patients. There was no statistical difference in the odds of initial cochlear implantation, age at referral, or age at implantation between the 2 groups. The odds of prelingual Medicaid-insured patients receiving sequential bilateral cochlear implantation was less than half that of the privately insured group (odds ratio [OR], 0.43; P=.03). The odds of complications in Medicaid-insured children were almost 5-fold greater than the odds for privately insured children (OR, 4.6; P=.03). There were 10 complications in 51 Medicaid-insured patients (19.6%) as opposed to 3 in 61 privately insured patients (4.9%). Medicaid-insured patients missed substantially more follow-up appointments overall (35% vs 23%) and more consecutive visits (1.9 vs 1.1) compared with privately insured patients.Conclusions: In an environment with adequate Medicaid reimbursement, eligible children have equal access to cochlear implantation, regardless of socioeconomic background. However, lower socioeconomic background is associated with higher rates of postoperative complications, worse follow-up compliance, and lower rates of sequential bilateral implantation, observed herein in Medicaid-insured patients. These findings present opportunities for cochlear implant centers to create programs to address such downstream disparities.