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: 10621921
• 负责人: Laura Chavez
• 金额: $ 46.08万
• 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/10621921
• 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; Equity; Ethnic Origin; Ethnic Population; 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; Procedures; Process; Professional Organizations; Provider; Quality of life; Race; Recommendation; Recurrence; Research; Resolution; Rural; Sampling; Sleep Apnea Syndromes; Socioeconomic Status; Surgeon; Symptoms; Time; Tonsil; Tonsillectomy; Tonsillitis; Trust; United Kingdom; United States; Variant; accountable care organization; community-level factor; cost; effective therapy; ethnic difference; expectation; experience; geographic difference; health care service utilization; improved; medical specialties; preference; primary care practice; primary care provider; racial difference; racial population; 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，有或没有腺样体切除术，是最常见的外科手术之一 美国，每年有50万名儿童。儿童中的扁桃体切除术最多 通常用于阻塞性睡眠失调的呼吸（OSDB）或复发性喉咙感染。这 程序可改善OSDB儿童的OSDB症状，行为和生活质量。这也是一个有效的 严重复发性扁桃体炎儿童的治疗。然而，许多孩子经历了 随着时间的流逝，OSDB或轻度扁桃体感染而无需进行手术。因此，扁桃体切除术受到 某些组的使用差异很大，并且可能过度使用。潜在过度使用的证据来自 乡村白人儿童的扁桃体切除术发生率比 非农村白人儿童或黑人或西班牙裔儿童。相反，黑人和西班牙裔孩子很远 比白人儿童更有可能患有OSDB，但为此，他们不太可能进行扁桃体切除术 健康）状况。跨多个级别和域作用的因素可能会驱动这些差异 扁桃体切除术的使用，包括在患者/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。尽管通常认为大型社会人口统计学和 扁桃体切除术中看到的地理变化在很大程度上由不同的意见和偏好来解释 提供者，大量研究表明，患者的知识，偏好和期望为 与提供者对成人选举率的社会人口统计学差异相比，影响者的影响很大或更大 外科手术。了解患者/家庭，临床医生和社区级因素的相对重要性 种族/种族和小儿扁桃体切除术的地理差异至关重要以最大化 这种常见手术程序在小儿人群中的好处，同时最大程度地减少不必要的费用 和与之相关的并发症。这个混合方法项目将识别并量化影响 小儿种族/种族和地理差异的多个级别和领域作用的因素 扁桃体切除术。我们将分析2016 - 2019年所有公开保险的美国的医疗保健利用数据 孩子们。我们还将与孩子们经历的各种照顾者进行采访 扁桃体切除术以及参考扁桃体切除术的耳鼻喉科医生的PCP。我们的发现会 促进未来改善护理儿童被视为扁桃体切除术的适当性 告知发展并有针对性地传播教育材料并分享决策 家庭和临床医生可以使用的工具。