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.

项目总结/文摘