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Wagner CS, Barrero CE, Kumar SL, Pontell ME, Salinero LK, Bartlett SP, Taylor JA, Folsom N, Swanson JW. Characterizing Interventions and Family Assistance of a Nurse Navigation Program in Orofacial Cleft Care. Cleft Palate Craniofac J 2024; 61:1164-1171. [PMID: 36895093 DOI: 10.1177/10556656231163397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE Characterize the interventions and assistance employed by a cleft nurse navigator (CNN) which have mediated improvement in care equity at our institution. DESIGN Retrospective study. SETTING Academic tertiary care center. PATIENTS, PARTICIPANTS Patients presenting with cleft lip and/or cleft palate presenting between August 2020 and August 2021 with exclusions for syndromic diagnosis, Pierre-Robin sequence, late (> 6 months) presentation, and prior cleft surgery at outside institutions. INTERVENTIONS Multidisciplinary cleft nurse navigator program. MAIN OUTCOME MEASURE(S) Family interactions with the CNN by phone, text, and email across the first year of life including feeding support, nasoalveolar molding (NAM) assistance, appointment scheduling, financial assistance, addressing perioperative concerns, and facilitating physician consults. Patient weight and surgical timing were also recorded. RESULTS Sixty-nine patients were included with a total of 639 interactions between the CNN and families. Scheduling support (30%), addressing perioperative concerns (22%), and feeding support (20%) were the most common interactions. Feeding support and NAM assistance were heavily distributed in the first 3 months of life compared to after 3 months (P < .001). Median age at first contact was 1 week (range: 22 weeks gestation-14 weeks). There was no difference in the proportion of families receiving feeding support, NAM assistance, or scheduling assistance based on insurance status or race (P > .05 for all). CONCLUSIONS Scheduling assistance, addressing perioperative concerns, and feeding support are the predominant methods by which the CNN interacts with and assists families of patients with cleft conditions. CNN service distribution is largely equitable between demographic groups.
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Affiliation(s)
- Connor S Wagner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carlos E Barrero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Satvika L Kumar
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew E Pontell
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lauren K Salinero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nancy Folsom
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Villavisanis DF, Wagner CS, Morales CZ, Smith TE, Blum JD, Cho DY, Bartlett SP, Taylor JA, Swanson JW. Geospatial and Socioeconomic Factors Interact to Predict Management and Outcomes in Cleft Lip and Palate Surgery: A Single Institution Study of 740 Patients. Cleft Palate Craniofac J 2024; 61:921-929. [PMID: 36802891 DOI: 10.1177/10556656221150291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE Determine interactions between geospatial and socioeconomic factors influencing cleft lip and/or cleft palate (CL/P) management and outcomes. DESIGN Retrospective review and outcomes analysis (n = 740). SETTING Urban academic tertiary care center. PATIENTS 740 patients undergoing primary (CL/P) surgery from 2009 to 2019. MAIN OUTCOMES MEASURES Prenatal evaluation by plastic surgery, nasoalveolar molding, cleft lip adhesion, and age at CL/P surgery. RESULTS Prenatal evaluation by plastic surgery was predicted by the interaction between higher patient median block group income and shorter patient distance from the care center (OR = 1.07, p = 0.022). Nasoalveolar molding was also predicted by the interaction between higher patient median block group income and shorter distance from the care center (OR = 1.28, p = 0.016), whereas cleft lip adhesion was predicted by higher patient median block group income alone (OR = 0.41, p < 0.001). Lower patient median block group income predicted later age at cleft lip (β = -67.25, p = 0.011) and cleft palate (β = -46.35, p = 0.050) repair surgery. CONCLUSIONS Distance from the care center and lower median income by block group interacted to significantly predict prenatal evaluation by plastic surgery and nasoalveolar molding for patients with CL/P at a large, urban, tertiary care center. Patients living farthest from the care center who received prenatal evaluation by plastic surgery or who underwent nasoalveolar molding had higher median block group income. Future work will determine mechanisms perpetuating these barriers to care.
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Affiliation(s)
- Dillan F Villavisanis
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Connor S Wagner
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carrie Z Morales
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tony E Smith
- Department of Electrical & Systems Engineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica D Blum
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Y Cho
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Barr J, Mackie A, Gorelik D, Buckingham H, Clark D, Brissett AE. Health Disparities Research in Facial Plastic and Reconstructive Surgery: A Scoping Review. Otolaryngol Head Neck Surg 2024. [PMID: 38796736 DOI: 10.1002/ohn.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 05/04/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Health disparities contribute significantly to disease, health outcomes, and access to care. Little is known about the state of health disparities in facial plastic and reconstructive surgery (FPRS). This scoping review aims to synthesize the existing disparities research in FPRS and guide future disparities-related efforts. DATA SOURCES PubMed, Embase, Web of Science. REVIEW METHODS We conducted a scoping review in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Our search included all years through March 03, 2023. All peer-reviewed primary literature of any design related to disparities in FPRS was eligible for inclusion. RESULTS Of the 12283 unique abstracts identified, 215 studies underwent full-text review, and 108 remained for final review. The most frequently examined topics were cleft lip and palate (40.7%), facial trauma (29.6%), and gender affirmation (9.3%). There was limited coverage of other areas. Consideration of race/ethnicity (68.5%), socioeconomic status (65.7%), and gender/sex (40.7%) were most common. Social capital (0%), religion, occupation, and features of relationships were least discussed (0.01% each). The majority of studies were published after 2018 (59.2%) and were of nonprospective designs (95.4%). Most studies focused on disparity detection (80.6%) and few focused on understanding (13.9%) or reducing disparities (0.06%). CONCLUSION This study captures the existing literature on health disparities in FPRS. Studies are concentrated in a few areas of FPRS and are primarily in the detecting phase of public health research. Our review highlights several gaps and opportunities for future disparities-related focus.
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Affiliation(s)
- Jeremy Barr
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Aaron Mackie
- School of Medicine, Texas A&M University, Bryan, Texas, USA
| | - Daniel Gorelik
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
| | - Hannah Buckingham
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Delaney Clark
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Anthony E Brissett
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
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Villavisanis DF, Blum JD, Plana NM, Taub PJ, Taylor JA. Choosing a Multidisciplinary Cleft and Craniofacial Team: Medical, Surgical, and Social Considerations. Cleft Palate Craniofac J 2024; 61:518-522. [PMID: 36168208 DOI: 10.1177/10556656221129967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cleft and craniofacial conditions often present with a variety of functional and esthetic sequelae optimally treated by a multidisciplinary approach. Diagnosis of such conditions pre- or postnatally may evoke parental uncertainty and anxiety, and an important primary consideration is the selection of a cleft and craniofacial team. Identifying an optimal team may be particularly important for developing long-term relationships with clinicians who will ideally work intimately with the family from diagnosis to adulthood. While families, parents, and providers should consider several factors, a dearth of evidence-based suggestions preclude critical appraisal of cleft and craniofacial teams. In this article, the authors summarize medical, surgical, and social considerations for selecting a cleft and craniofacial team to optimize patient outcomes and the family/caregiver experience.
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Affiliation(s)
- Dillan F Villavisanis
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Plastic & Reconstructive Surgery, Mount Sinai Health System, New York, NY, USA
| | - Jessica D Blum
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie M Plana
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter J Taub
- Division of Plastic & Reconstructive Surgery, Mount Sinai Health System, New York, NY, USA
| | - Jesse A Taylor
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Alrubaiaan R, Nair B, Amir-Rad F, Aljanahi M, Kumar S V, Prasad S. Presurgical Infant Orthopedic Videos on YouTube™: A Thematic Analysis of Caregiver Narratives. Cleft Palate Craniofac J 2024:10556656241233115. [PMID: 38389436 DOI: 10.1177/10556656241233115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE Information regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers' perspectives and experiences with contemporary PSIO treatment. DESIGN PSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019). RESULTS Two themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits. CONCLUSION Multifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.
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Affiliation(s)
- Raed Alrubaiaan
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Bhavana Nair
- Guidance & Counseling Office, Student Life, Mohammed Bin Rashid University of Medicine and HealthSciences, Dubai, United Arab Emirates
| | - Fatemeh Amir-Rad
- Department of Prosthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - May Aljanahi
- Program Director, Dental Internship, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Vijay Kumar S
- Department of Public Health Dentistry, Amrita School of Dentistry, Amritha Vishwa Vidyapeetham, Kochi , Kerala, India
| | - Sabarinath Prasad
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Park JJ, Alfonso AR, Kalra A, Staffenberg DA, Flores RL, Shetye PR. Defining the Treatment Gap in Nasoalveolar Molding: Factors Affecting the Utilization of NAM in an Urban Cleft Center. Cleft Palate Craniofac J 2024; 61:131-137. [PMID: 36560912 DOI: 10.1177/10556656221148030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many cleft centers incorporate NasoAlveolar Molding (NAM) into their presurgical treatment protocols. However, there are limited data on eligible patients who do not receive or complete NAM. This study characterizes the demographics associated with non-utilization or completion of NAM. METHODS A single-institution retrospective review was performed of all patients with cleft lip and alveolus undergoing primary unilateral and bilateral cleft lip repair from 2012-2020. Patients were grouped based on utilization or non-utilization of NAM. Demographic and treatment data were collected, including documented reasons for not pursuing or completing NAM. RESULTS Of 230 eligible patients, 61 patients (27%) did not undergo or complete NAM (no-NAM). In this group, 37 (60.7%) received no presurgical intervention, 12 (19.7%) received presurgical nostril retainers, 3 (4.9%) received lip taping, 1 (1.6%) received a combination of taping/nostril retainers, and 8 (13.1%) discontinued NAM. The most common reasons for not receiving NAM were sufficiently aligned cleft alveolus (21.3%), medical complexity (16.4%), late presentation (16.4%), and alveolar notching (18%). Compared to the NAM group, the no-NAM group had significantly lower rates of prenatal cleft diagnosis/consult, and significantly higher proportion of non-married and non-English speaking caregivers. Multivariable analysis controlling for insurance type, primary language, prenatal consult, marital status, and age at first appointment found that age at first appointment is the only statistically significant predictor of NAM utilization (P < .001). CONCLUSIONS Common reasons for non-utilization of NAM include well-aligned cleft alveolus, medical complexity, and late presentation. Early presentation is an important modifiable factor affecting rates of NAM utilization.
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Affiliation(s)
- Jenn J Park
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Aneesh Kalra
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Pradip R Shetye
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
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Roohani I, Trotter C, Shakoori P, Moshal TA, Lasky S, Manasyan A, Wolfe EM, Magee WP, Hammoudeh JA. Lessons Learned from a Single Institution's Eight Years of Experience with Early Cleft Lip Repair. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1741. [PMID: 37893459 PMCID: PMC10608426 DOI: 10.3390/medicina59101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The traditional approach in managing wide cleft lip deformities involves presurgical nasoalveolar molding (NAM) therapy followed by surgical cleft lip repair between three and six months of age. This institution has implemented an early cleft lip repair (ECLR) protocol where infants undergo primary cleft lip repair between two and five weeks of age without NAM. This study aims to present this institution's ECLR repair protocol over the past eight years from 188 consecutive patients with unilateral or bilateral CL/P deformity. Materials and Methods: Retrospective review was conducted at Children's Hospital Los Angeles evaluating patients who underwent ECLR before three months of age and were classified as American Society of Anesthesiologists (ASA) class I or II from 2015-2022. Anthropometric analysis was performed, and pre- and postoperative photographs were evaluated to assess nasal and lip symmetry. Results: The average age at cleft lip repair after correcting for gestational age was 1.0 ± 0.5 months. Mean operative and anesthetic times were 120.3 ± 33.0 min and 189.4 ± 35.4, respectively. Only 2.1% (4/188) of patients had postoperative complications. Lip revision rates were 11.4% (20/175) and 15.4% (2/13) for unilateral and bilateral repairs, respectively, most of which were minor in severity (16/22, 72.7%). Postoperative anthropometric measurements demonstrated significant improvements in nasal and lip symmetry (p < 0.001). Conclusions: This analysis demonstrates the safety and efficacy of ECLR in correcting all unilateral cleft lip and nasal deformities of patients who were ASA classes I or II. At this institution, ECLR has minimized the need for NAM, which is now reserved for patients with bilateral cleft lip, late presentation, or comorbidities that preclude them from early repair. ECLR serves as a valuable option for patients with a wide range of cleft severity while reducing the burden of care.
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Affiliation(s)
- Idean Roohani
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Collean Trotter
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Pasha Shakoori
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA; (P.S.); (E.M.W.)
| | - Tayla A. Moshal
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Sasha Lasky
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Artur Manasyan
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Erin M. Wolfe
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA; (P.S.); (E.M.W.)
| | - William P. Magee
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA; (P.S.); (E.M.W.)
| | - Jeffrey A. Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA; (P.S.); (E.M.W.)
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8
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Trends in insurance coverage for adolescent reduction mammaplasty. Am J Surg 2022; 224:1068-1073. [DOI: 10.1016/j.amjsurg.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 07/31/2022] [Indexed: 11/22/2022]
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Morris MP, Christopher AN, Patel V, Broach RB, Fischer JP, Butler PD. Assessing Disparities in Reduction Mammaplasty: There Is Room for Improvement. Aesthet Surg J 2021; 41:NP796-NP803. [PMID: 33735387 DOI: 10.1093/asj/sjab138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Racial and socioeconomic disparities in access and quality of surgical care are well documented in many surgical subspecialties, including plastic surgery. OBJECTIVES The authors aimed to determine if demographic disparities exist in preoperative and postoperative satisfaction after breast reduction mammaplasty, utilizing patient-reported quality of life (QoL) scores. METHODS Patients who underwent breast reduction mammaplasty between 2015 and 2020 were identified. Patients who underwent complex concomitant procedures were excluded. Patient demographics and QoL, as measured by the BREAST-Q, were extracted. Wilcoxon Rank Sum and Kruskal-Wallis tests were employed to compare QoL scores across demographic subgroups. RESULTS A total of 115 patients met the inclusion criteria. QoL improved across all 4 BREAST-Q domains (all P < 0.001). Disparities were shown to exist in the following: median income vs postoperative satisfaction with information (P < 0.001), BMI vs preoperative physical well-being (P < 0.001), and ethnicity vs preoperative physical well-being (P = 0.003). A sub-group analysis of Caucasian patients compared with Black/African American patients revealed significant inequalities in BMI (P < 0.001), median income by zip code (P < 0.001), improvement in satisfaction with breasts (P = 0.039), satisfaction with information (P = 0.007), and satisfaction with office staff (P = 0.044). CONCLUSIONS Racial and socioeconomic inequalities exist in preoperative and postoperative satisfaction for patients undergoing breast reduction mammaplasty. Institutions should focus on developing tools for equitable and inclusive patient education and perioperative counseling. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Martin P Morris
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Viren Patel
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robyn B Broach
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - John P Fischer
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Paris D Butler
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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10
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Wagner C, Zimmerman CE, Barrero C, Kalmar CL, Butler P, Guevara J, Bartlett SP, Taylor JA, Folsom N, Swanson JW. Reduced Socioeconomic Disparities in Cleft Care After Implementing a Cleft Nurse Navigator Program. Cleft Palate Craniofac J 2021; 59:320-329. [PMID: 33823655 DOI: 10.1177/10556656211005646] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a Cleft Nurse Navigator (CNN) program on care for patients with cleft lip and cleft palate and assess the programs efficacy to reduce existing socioeconomic disparities in care. DESIGN Retrospective review and outcomes analysis (n = 739). SETTING Academic tertiary care center. PATIENTS All patients presenting with cleft lip and/or cleft palate (CL/P) born between May 2009 and November 2019 with exclusions for atypical clefts, submucous cleft palates, international adoption, and very late presentation (after 250 days of life). INTERVENTIONS Multidisciplinary care coordination program facilitated by the CNN. MAIN OUTCOME MEASURES Patient age at first outpatient appointment and age at surgery, reported feeding issues, weight gain, and patient-cleft team communications. RESULTS After CNN implementation, median age at outpatient appointment decreased from 20 to 16 days (P = .021), volume of patient-cleft team communications increased from 1.5 to 2.8 (P < .001), and frequency of reported feeding concerns decreased (50% to 35%; P < .001). In the pre-CNN cohort, nonwhite and publicly insured patients experienced delays in first outpatient appointment (P < .001), cleft lip repair (P < .011), and cleft palate repair (P < .019) compared to white and privately insured patients, respectively. In the post-CNN cohort, there were no significant differences in first appointment timing by race nor surgical timing on the basis of racial identity nor insurance type. CONCLUSIONS A variety of factors lead to delays in cleft care for marginalized patient populations. These findings suggest that a CNN can reduce disparities of access and communication and improve early feeding in at-risk cohorts.
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Affiliation(s)
- Connor Wagner
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, PA, USA
| | - Carrie E Zimmerman
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, PA, USA
| | - Carlos Barrero
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, PA, USA
| | - Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Paris Butler
- Division of Plastic and Reconstructive Surgery, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - James Guevara
- Division of General Pediatrics, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, PA, USA
| | - Nancy Folsom
- Division of Plastic and Reconstructive Surgery, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, PA, USA.,Division of Plastic and Reconstructive Surgery, 6572University of Pennsylvania, Philadelphia, PA, USA
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