声带黏膜切除术后嗓音治疗选择的实践差异
Practice variations in voice treatment selection following vocal fold mucosal resection.
作者信息
Moore Jaime E, Rathouz Paul J, Havlena Jeffrey A, Zhao Qianqian, Dailey Seth H, Smith Maureen A, Greenberg Caprice C, Welham Nathan V
机构信息
Division of Otolaryngology, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
出版信息
Laryngoscope. 2016 Nov;126(11):2505-2512. doi: 10.1002/lary.25911. Epub 2016 Mar 12.
OBJECTIVES/HYPOTHESIS: To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population.
STUDY DESIGN
Retrospective analysis of a large, nationally representative Medicare claims database.
METHODS
Patients with > 12 months of continuous Medicare coverage who underwent a leukoplakia- or cancer-related vocal fold mucosal resection (index) procedure during calendar years 2004 to 2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each postindex treatment type, treating the other treatment types as competing risks, and further evaluated postindex treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex, and Medicaid eligibility were used as predictors.
RESULTS
A total of 2,041 patients underwent 2,427 index procedures during the study period. In 14% of cases, an initial voice treatment event was identified. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65 to 75 years, the likelihood of undergoing surgical treatment increased significantly with each 5-year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy.
CONCLUSION
The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age, and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care.
LEVEL OF EVIDENCE
2c. Laryngoscope, 126:2505-2512, 2016.
目的/假设：描述医疗保险人群中声带黏膜切除术后初始嗓音治疗的选择情况。
研究设计
对一个具有全国代表性的大型医疗保险索赔数据库进行回顾性分析。
方法
研究对象为2004年至2009年期间连续参加医疗保险超过12个月且接受了与白斑或癌症相关的声带黏膜切除（索引）手术的患者。主要关注的结局是索引手术后接受初始嗓音治疗（甲状成形术、声带注射或言语治疗）的情况。我们评估了每种索引后治疗类型的累积发生率，将其他治疗类型视为竞争风险，并使用竞争风险子分布的比例风险模型进一步评估索引后治疗的利用率。将患者年龄、性别和医疗补助资格用作预测因素。
结果
在研究期间，共有2041例患者接受了2427次索引手术。在14%的病例中，发现了初始嗓音治疗事件。与男性相比，女性接受手术或行为治疗的可能性显著降低。从65岁到75岁，每增加5岁，接受手术治疗的可能性显著增加；75岁以后，每5年接受手术或行为治疗的可能性显著降低。社会经济地位较低的患者接受言语治疗的可能性显著降低。
结论
大多数医疗保险患者在声带黏膜切除术后未接受嗓音治疗。此外，基于患者的性别、年龄和社会经济地位，这里分析的治疗方法似乎使用比例失调。需要进一步研究以确定这些观察结果是否反映了临床上可解释的差异或护理差异。
证据水平
2c。《喉镜》，2016年，第126卷，第2505 - 2512页。
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