Disparities in Healthcare Utilization: An Analysis of Disease Specific and Patient Level Factors in a Congenital Diaphragmatic Hernia Clinic.

Autor: Cimbak N; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Fegan 3, 300 Longwood Ave, Boston, MA 02115, USA. Electronic address: nicole.cimbak@childrens.harvard.edu., Zalieckas JM; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Fegan 3, 300 Longwood Ave, Boston, MA 02115, USA., Staffa SJ; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Fegan 3, 300 Longwood Ave, Boston, MA 02115, USA., Lemire L; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Fegan 3, 300 Longwood Ave, Boston, MA 02115, USA., Janeczek J; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Fegan 3, 300 Longwood Ave, Boston, MA 02115, USA., Sheils C; Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA., Visner G; Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA., Mullen M; Department of Cardiology and Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA., Studley M; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA., Becker R; Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA., Dickie BH; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Fegan 3, 300 Longwood Ave, Boston, MA 02115, USA., Demehri FR; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Fegan 3, 300 Longwood Ave, Boston, MA 02115, USA., Buchmiller TL; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Fegan 3, 300 Longwood Ave, Boston, MA 02115, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Oct; Vol. 59 (10), pp. 161569. Date of Electronic Publication: 2024 May 07.
DOI: 10.1016/j.jpedsurg.2024.04.023
Abstrakt: Objectives: Our study examines if the disease severity profile of our Congenital Diaphragmatic Hernia (CDH) patient cohort adherent to long-term follow-up differs from patients lost to follow-up after discharge and examines factors associated with health care utilization.
Methods: Retrospective review identified CDH survivors born 2005-2019 with index repair at our institution. Primary outcome was long-term follow-up status: "active" or "inactive" according to clinic guidelines. Markers of CDH disease severity including CDH defect classification, oxygen use, tube feeds at discharge, and sociodemographic factors were examined as exposures.
Results: Of the 222 included patients, median age [IQR] was 10.2 years [6.7-14.3], 61% male, and 57 (26%) were insured by Medicaid. Sixty-three percent (139/222) of patients were adherent to follow-up. Seventy-six percent of patients discharged on tube feeds had active follow-up compared to 55% of patients who were not, with similar findings for oxygen at discharge (76% vs. 55%). Kaplan-Meier analysis showed patients with smaller defect size had earlier attrition compared to patients with larger defect size. Other race (Hispanic, Asian, Middle Eastern) patients had 2.87 higher odds of attrition compared to white patients (95% CI 1.18-7.0). Medicaid patients had 2.64 higher odds of attrition compared to private insurance (95% CI 1.23-5.66).
Conclusion: Loss to follow-up was associated with race and insurance type. Disease severity was similar between the active and inactive clinic cohorts. Long-term CDH clinic publications should examine attrition to ensure reported outcomes reflect the discharged population. This study identified important factors to inform targeted interventions for follow-up adherence.
Level of Evidence: Level III.
Competing Interests: Conflicts of interest Dr. Mary Mullen, discloses being on the Scientific Advisory Board of Altavant Sciences in November 2021. She completed this work in November 2021 and it was outside the scope of this manuscript.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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