Lack of financial barriers to pediatric cochlear implantation: impact of socioeconomic status on access and outcomes.
ABSTRACT (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.
Retrospective cohort study.
University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital (tertiary referral center), Cleveland, Ohio.
Pediatric patients (age range, newborn to 18 years) who received unilateral cochlear implantation during the period 1996 to 2008.
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.
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.
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.
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ABSTRACT: ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effect of early preventive dental visits on subsequent dental treatment and expenditures. Beil H, Rozier RG, Preisser JS, Stearns SC, Lee JY. Med Care 2012 Sep;50(9):749-56. REVIEWER: Jonathan D. Shenkin, DDS, MPH PURPOSE/QUESTION: To determine dental treatment procedures at ages 43 to 72 months among children who received a dental preventive visit before 18 months of age versus those who received them up to 42 months of age SOURCE OF FUNDING: US Agency for Healthcare Research and Quality and the National Institutes of Health TYPE OF STUDY/DESIGN: Retrospective cohort study LEVEL OF EVIDENCE: Level 3 STRENGTH OF RECOMMENDATION GRADE: Not applicable.The journal of evidence-based dental practice 03/2013; 13(1):31-32. DOI:10.1016/j.jebdp.2013.01.001
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ABSTRACT: Objectives Early intervention for children with hearing loss involves assistance in oral speech development, optimal use of hearing devices and fostering a holistic partnership between allied health and the children's families. Adequate access to early intervention has been shown to be vital in the positive development of long term language and social outcomes. However, there has been limited research to identify the factors which may influence access. This study aimed to explore whether access to early intervention by children with hearing loss is affected by: geographical location, socio-economic status and ethnic-minority family status. Methods A cross-sectional research design was used in this study incorporating a survey of early intervention coordinators and an audit of an organization database. All (N = 11) early intervention coordinators at an “Oral Language Centre for Deaf Children” in the state of Victoria, Australia were surveyed on whether child clients (N = 133) were accessing an appropriate level of early intervention corresponding to their level of hearing loss. The length of time for each child to enroll for early intervention following diagnosis was obtained from the database of the organization. Potential differences in access between geographical groups, between socio-economic status groups and between ethnic-minority and non-minority group were analyzed using inferential statistics. Results Closer geographical proximity to early intervention services was associated with more appropriate (P=.000) and more prompt (P=.005) access. No difference in access to early intervention was detected for different socio-economic status groups. Although, ethnic-minority family status was not shown to influence the level of access, it took a significantly longer time for ethnic-minority families to enroll for early intervention compared to non-minority families (P=.04). Conclusions Findings suggest that geographical proximity and ethnic-minority family status, instead of socio-economic status, are more likely to be potential barriers to early intervention access in children with hearing loss. From the health promotion perspective, attention should be directed towards these potential barriers.International journal of pediatric otorhinolaryngology 03/2014; 78(3). DOI:10.1016/j.ijporl.2013.12.032 · 1.32 Impact Factor
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ABSTRACT: OBJECTIVES:: Cochlear implantation (CI) has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence of the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation-a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the present study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost utility of pediatric CI by age at intervention will be analyzed. DESIGN:: Prospective, longitudinal assessment of health utility and educational placement outcomes in 175 children recruited from six U.S. centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent CI before 5 years of age, and had up to 6 years of postimplant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratified by preoperative, operative, and postoperative expenditures. Incremental costs and benefits of implantation were compared among the three age groups and relative to a nonimplantation baseline. RESULTS:: Children implanted at <18 months of age gained an average of 10.7 quality-adjusted life years (QALYs) over their projected lifetime as compared with 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different among the three age groups. In addition, mean lifetime costs of implantation were similar among the three groups, at approximately $2000/child/year (77.5-year life expectancy), yielding costs of $14,996, $17,849, and $19,173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared with 57 and 63% for the middle and oldest groups, respectively (p < 0.05) after 6 years of follow-up. After incorporating lifetime educational cost savings, CI led to net societal savings of $31,252, $10,217, and $6,680 for the youngest, middle, and oldest groups at CI, respectively, over the child's projected lifetime. CONCLUSIONS:: Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with CI was associated with greater and longer quality-of-life improvements, similar direct costs of implantation, and economically valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to CI at older ages.Ear and hearing 02/2013; 34(4). DOI:10.1097/AUD.0b013e3182772c66 · 2.83 Impact Factor