Yang Charles Q, Reilly Brian K, Preciado Diego A
Department of Otolaryngology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
Department of Otolaryngology, Children's National Medical Center, Washington, D.C., 111 Michigan Ave NW, Washington, DC 20010, USA.
Int J Pediatr Otorhinolaryngol. 2018 Jan;104:224-227. doi: 10.1016/j.ijporl.2017.11.026. Epub 2017 Nov 28.
This study aims to (1) determine barriers in the pediatric cochlear implantation process specific to publicly insured patients, wherein delayed implantation has been reported, and (2) compare the perceived barriers between publicly and privately insured patients.
Tertiary care cochlear implantation center at academic pediatric hospital.
Cross-sectional survey, retrospective chart review.
The validated, 39 item Barriers to Care Questionnaire was administered to the parents of 80 recipients of cochlear implantation by two surgeons between 2013 and 2016. Survey results and diagnosis to implant interval were compared based on public or private insurance status. Two-tailed Mann-Whitney and Fisher's exact test was used for statistical analysis.
Of 110 cochlear implants, 27 of 80 (34%) English-speaking parents completed the survey. 15 were privately insured and 12 were publicly insured. 23 of 27 respondents received cochlear implantation for pre-lingual sensorineural hearing loss. Publicly insured patients had significantly longer median time from diagnosis to implant than privately insured (19 vs. 8 mo, p = 0.01). The three worst scoring barrier categories for privately insured families in order were Pragmatics, Expectations, and Marginalization, whereas for publicly insured families it was Pragmatics, Skills, and Expectations. The worst scoring question for privately insured patients was "Having to take time off work". For the publicly insured, it was "Lack of communication."
Privately insured patients reported more barriers on the Barriers to Care Questionnaire than publicly insured patients did. Although pragmatics was the worst-scoring barrier category for both groups, difficulties found on the survey ranked differently for each group. This information can help providers address disparities and access barriers for vulnerable patients.
本研究旨在（1）确定公共保险患者在儿科人工耳蜗植入过程中存在的特定障碍，据报道这些患者存在植入延迟的情况，以及（2）比较公共保险患者和私人保险患者所感知到的障碍。
学术性儿科医院的三级护理人工耳蜗植入中心。
横断面调查、回顾性病历审查。
2013年至2016年间，两名外科医生向80名人工耳蜗植入接受者的父母发放了经过验证的、包含39个条目的《护理障碍问卷》。根据公共或私人保险状况比较调查结果和诊断至植入的间隔时间。采用双尾曼-惠特尼检验和费舍尔精确检验进行统计分析。
在110例人工耳蜗植入中，80名（34%）说英语的父母完成了调查。15名有私人保险，12名有公共保险。27名受访者中有23名因语前感音神经性听力损失接受了人工耳蜗植入。公共保险患者从诊断到植入的中位时间显著长于私人保险患者（19个月对8个月，p = 0.01）。私人保险家庭得分最差的三个障碍类别依次是语用学、期望和边缘化，而公共保险家庭则是语用学、技能和期望。私人保险患者得分最差的问题是“不得不请假”。对于公共保险患者来说，是“缺乏沟通”。
在《护理障碍问卷》中，私人保险患者报告的障碍比公共保险患者更多。尽管语用学是两组得分最差的障碍类别，但调查中发现的困难在每组中的排名不同。这些信息有助于医疗服务提供者解决弱势患者的差异和获取障碍问题。
