Cole Jordan J, Sellitto Angela D, Baratta Laura Rosa, Huecker Julia B, Balls-Berry Joyce E, Gurnett Christina A
Washington University in St. Louis, Department of Neurology.
University of Colorado, Department of Pediatrics.
medRxiv. 2023 Sep 13:2023.09.12.23295450. doi: 10.1101/2023.09.12.23295450.
To investigate clinical, social, and systems-level determinants predictive of genetics clinic referral and completion of genetics clinic visits among child neurology patients.
Electronic health record data were extracted from patients 0-18 years old who were evaluated in child neurology clinics at a single tertiary care institution between July 2018 to January 2020. Variables aligned with the Health Equity Implementation Framework. Referral and referral completion rates to genetics and cardiology clinics were compared among Black vs White patients using bivariate analysis. Demographic variables associated with genetics clinic referral and visit completion were identified using logistic regressions.
In a cohort of 11,371 child neurology patients, 304 genetics clinic referrals and 82 cardiology clinic referrals were placed. In multivariate analysis of patients with Black or White ethnoracial identity (n=10,601), genetics clinic referral rates did not differ by race, but were significantly associated with younger age, rural address, neurodevelopmental disorder diagnosis, number of neurology clinic visits, and provider type. The only predictors of genetics clinic visit completion number of neurology clinic visits and race/ethnicity, with White patients being twice as likely as Black patients to complete the visit. Cardiology clinic referrals and visit completion did not differ by race/ethnicity.
Although race/ethnicity was not associated with differences in genetics clinic referral rates, White patients were twice as likely as Black patients to complete a genetics clinic visit after referral. Further work is needed to determine whether this is due to systemic/structural racism, differences in attitudes toward genetic testing, or other factors.
探讨儿童神经科患者中预测基因门诊转诊及完成基因门诊就诊的临床、社会和系统层面的决定因素。
从2018年7月至2020年1月在一家三级医疗中心的儿童神经科门诊接受评估的0至18岁患者中提取电子健康记录数据。变量与健康公平实施框架一致。使用双变量分析比较黑人和白人患者转诊至基因门诊和心脏科门诊的转诊率及转诊完成率。使用逻辑回归确定与基因门诊转诊和就诊完成相关的人口统计学变量。
在11371名儿童神经科患者队列中，进行了304次基因门诊转诊和82次心脏科门诊转诊。在对具有黑或白人种族身份的患者（n = 10601）进行的多变量分析中，基因门诊转诊率在种族上没有差异，但与年龄较小、居住在农村、神经发育障碍诊断、神经科门诊就诊次数和医疗服务提供者类型显著相关。基因门诊就诊完成的唯一预测因素是神经科门诊就诊次数和种族/民族，白人患者完成就诊的可能性是黑人患者的两倍。心脏科门诊转诊和就诊完成在种族/民族方面没有差异。
尽管种族/民族与基因门诊转诊率的差异无关，但白人患者在转诊后完成基因门诊就诊的可能性是黑人患者的两倍。需要进一步研究以确定这是由于系统性/结构性种族主义、对基因检测的态度差异还是其他因素所致。
