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

项目总结/摘要 扁桃体切除术，伴或不伴腺样体切除术，是扁桃体切除术中最常见的外科手术之一。 在美国，每年有超过50万名儿童接受手术。儿童扁桃体切除术是最 通常用于阻塞性睡眠呼吸障碍（oSDB）或复发性咽喉感染。的 治疗可改善oSDB患儿的oSDB症状、行为和生活质量。它也是一种有效的 治疗儿童严重复发性扁桃体炎。然而，许多孩子经历了一个解决方案， oSDB或轻度扁桃体感染随着时间的推移而没有手术。因此，扁桃体切除术 在某些群体中，使用和可能过度使用存在相当大的差异。潜在过度使用的证据来自于 事实上，农村白色儿童的扁桃体切除率比农村儿童高2-3倍， 非农村白色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 比白色儿童更有可能患有oSDB，但他们不太可能为此接受扁桃体切除术 条件很可能是跨多个层次和领域的因素推动了这些差异， 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。尽管人们通常认为大量的社会人口和 扁桃体切除术使用的地理差异主要是由不同的意见和偏好解释的， 提供者，大量的研究表明，病人的知识，偏好和期望， 对成人选修率的社会人口统计学差异的影响大于或大于提供者的意见 手术了解患者/家庭、临床医生和社区层面因素对 儿童扁桃体切除术使用的种族/民族和地理差异是至关重要的， 这种常见手术在儿科人群中的益处，同时最大限度地减少不必要的费用 以及与之相关的并发症。这个混合方法项目将确定和量化影响 多个水平和领域的因素对儿科患者的种族/民族和地理差异起作用 扁桃体切除术使用。我们将分析2016-2019年美国所有公共保险的医疗保健利用数据。 孩子我们还将对不同样本的照顾者进行采访，这些照顾者的孩子经历了 扁桃体切除术，并与PCP谁是指和耳鼻喉科医生谁执行扁桃体切除术。我们的发现将 通过以下方式促进今后改善对考虑进行扁桃体切除术的儿童的适当护理： 为教材的编制和有针对性的传播以及共同决策提供信息 家庭和临床医生可以使用的工具。

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.