Racial/ethnic and geographic differences in pediatric tonsillectomy use: a multilevel investigation

儿科扁桃体切除术使用中的种族/民族和地理差异：多层次调查

• 批准号: 10444567
• 负责人: Jennifer N. Cooper
• 金额: $ 55.88万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-13 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444567
• 关键词: Adenoidectomy; Adult; Affect; Automobile Driving; Behavior; Black race; Caregivers; Caring; Child; Child Care; Childhood; Communities; Consultations; Data; Decision Making; Development; Educational Materials; Elective Surgical Procedures; Ethnic group; Evaluation; Family; Future; Geographic Locations; Geography; Guidelines; Health Personnel; Hispanic; Infection; Intervention; Interview; Investigation; Knowledge; Medicaid; Methods; NIH Program Announcements; National Institute on Minority Health and Health Disparities; Obstructive Sleep Apnea; Only Child; Operative Surgical Procedures; Otolaryngologist; Patients; Pediatric Surgical Procedures; Pharyngeal structure; Population; Primary Health Care; Procedures; Process; Professional Organizations; Provider; Quality of life; Recurrence; Research; Resolution; Rural; Sampling; Sleep Apnea Syndromes; Socioeconomic Status; Surgeon; Symptoms; Time; Tonsil; Tonsillectomy; Tonsillitis; Trust; United Kingdom; United States; Variant; care providers; community-level factor; cost; effective therapy; ethnic difference; expectation; experience; geographic difference; health care service utilization; improved; medical specialties; preference; racial and ethnic; response; rural area; rurality; shared decision making; sociodemographics; surgical disparities; tool

Project Summary/Abstract Tonsillectomy, with or without adenoidectomy, is one of the most common surgical procedures in the United States, performed in more than 500,000 children annually. Tonsillectomies in children are most commonly performed for obstructive sleep disordered breathing (oSDB) or recurrent throat infection. The procedure improves oSDB symptoms, behavior, and quality of life in children with oSDB. It is also an effective treatment for children with severe recurrent tonsillitis. Nevertheless, many children experience a resolution of oSDB or mild tonsillar infections over time without having surgery. As such, tonsillectomy is subject to considerable variation in use and likely overuse in some groups. Evidence of potential overuse comes from the fact that the rate of tonsillectomy for recurrent throat infection is 2-3 times higher in rural white children than non-rural white children or either black or Hispanic children. In contrast, black and Hispanic children are far more likely than white children to have oSDB, but they are less likely to undergo tonsillectomy for this condition. It is likely that factors acting across multiple levels and domains drive these differences in tonsillectomy use, including factors acting at the patient/family, primary care provider (PCP), primary care practice, surgeon, and community levels. Although it is often supposed that the large sociodemographic and geographic variation seen in tonsillectomy use is largely explained by the varying opinions and preferences of providers, a large body of research suggests that patient knowledge, preferences, and expectations have as great or greater an impact than provider opinion on sociodemographic differences in rates of adult elective surgery. An understanding of the relative importance of patient/family, clinician, and community-level factors on racial/ethnic and geographic differences in pediatric tonsillectomy use is critically needed to maximize the benefits of this common surgical procedure in the pediatric population, while minimizing the unnecessary costs and complications with which it is associated. This mixed-methods project will identify and quantify the impact of factors acting across multiple levels and domains on racial/ethnic and geographic differences in pediatric tonsillectomy use. We will analyze healthcare utilization data from 2016-2019 on all publicly insured U.S. children. We will also conduct interviews with diverse samples of caregivers whose children have undergone tonsillectomy and with PCPs who refer for and otolaryngologists who perform tonsillectomy. Our findings will facilitate future improvements in the appropriateness of care of children being considered for tonsillectomy by informing the development and targeted dissemination of educational materials and shared decision-making tools that can be used by families and clinicians.

项目摘要/摘要 扁桃体切除术，无论是不是腺样体切除术，都是最常见的外科手术之一。 在美国，每年有超过500,000名儿童参加表演。儿童扁桃体切除术最多 通常用于阻塞性睡眠呼吸障碍(OSDB)或反复喉咙感染。这个 该程序改善了患有oSDB的儿童的oSDB症状、行为和生活质量。它也是一种有效的 儿童重度复发性扁桃体炎的治疗。然而，许多孩子经历了一种解决 随着时间的推移，OSDB或轻微的扁桃体感染无需手术。因此，扁桃体切除术需要 在使用上有相当大的差异，在某些群体中可能过度使用。潜在过度使用的证据来自 事实是，在农村白人儿童中，扁桃体切除术治疗喉部复发感染的比率是 非农村白人儿童或黑人或西班牙裔儿童。相比之下，黑人和西班牙裔儿童远远 与白人儿童相比，他们更有可能患有oSDB，但他们不太可能为此接受扁桃体切除术 条件。这些差异很可能是由跨多个层次和领域的因素造成的 扁桃体切除术的使用，包括作用于患者/家庭、初级保健提供者(PCP)、初级保健的因素 实践、外科医生和社区层面。尽管人们经常认为，庞大的社会人口和 扁桃体切除术使用中的地理差异在很大程度上是由不同的观点和偏好解释的 提供者，大量研究表明，患者的知识、偏好和期望 对成人选修率的社会人口学差异的影响大于或大于提供者的意见 做手术。了解患者/家庭、临床医生和社区层面因素对疾病的相对重要性 儿童扁桃体切除术使用中的种族/民族和地理差异是至关重要的，以最大限度地提高 这种常见外科手术在儿科人群中的好处，同时将不必要的成本降至最低 以及与之相关的并发症。这一混合方法项目将确定和量化影响 跨多个层次和领域的因素对儿童种族/民族和地理差异的影响 扁桃体切除术的使用。我们将分析2016-2019年所有公共保险的美国医疗保健利用数据。 孩子们。我们还将对孩子们经历过的不同样本的照顾者进行访谈 扁桃体切除术和耳鼻喉科医生进行扁桃体切除术。我们的发现将 促进未来改善正在考虑进行扁桃体切除术的儿童的护理的适当性 为教育材料的开发和定向传播以及共同决策提供信息 可供家庭和临床医生使用的工具。