1
|
Lai LY, Lopez AD, Copp HL, Baradaran N, Breyer BN, Elaine Allen I, Hampson LA. Access and Utilization of Health Care by Adults with Spina Bifida. Urology 2023; 181:174-181. [PMID: 37690544 PMCID: PMC10842464 DOI: 10.1016/j.urology.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To contextualize the challenges that persons with congenital genitourinary conditions (CGC) may encounter in adulthood, we examined health care access, readiness for self-management, and health care utilization of adults with spina bifida (SB). METHODS Through surveys distributed via social media, persons with SB were asked about access and barriers to care, readiness for self-management, and health care utilization (ie, medical visits, missed visits, emergency room [ER] visits, hospital admissions) within the past year. Multivariable models were fitted to examine determinants of utilization. RESULTS Of the 270 eligible respondents (mean age 39), 24.5% had not received care from a urologist in the past year. The odds of missing any medical visits were increased among those with more prior urologic surgeries (odds ratio (OR) 1.35, 95%confidence interval (CI) 1.05-1.78) and those with ER visits for urologic condition within the past year (OR 2.65, 95%CI 1.22-6.01). Those with private insurance had lower odds of having ER visits for urologic condition (OR 0.46, 95%CI 0.22-0.84). The odds of hospital admission related to urologic condition were increased among female (OR 2.35, 95%CI 1.01-6.64), those with more prior urologic surgeries (OR 1.18, 95%CI 1.09-1.51), and those with a urologist (OR 2.98, 95%CI 1.15-14.47). CONCLUSION A substantial proportion of adults with CGC lack routine urologic care. Considering the significant barriers to care and lapses in care, efforts to improve access and optimize health care services utilization for this population with high medical complexity are warranted.
Collapse
Affiliation(s)
- Lillian Y Lai
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Alejandro D Lopez
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Hillary L Copp
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - I Elaine Allen
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Lindsay A Hampson
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA.
| |
Collapse
|
2
|
Blubaum A, Lewis J, Frimberger D, Slobodov G. 9-Year Evaluation of a Transitional Care Program for Congenital Neurogenic Bladder Patients. Urology 2023; 180:285-290. [PMID: 37451365 DOI: 10.1016/j.urology.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To evaluate short and long-term adherence and nonadherence patterns within a staged transition clinic developed in 2014 to assist congenital neurogenic bladder patients transfer from pediatric to adult urologic care. METHODS We performed a retrospective chart review of all congenital neurogenic bladder patients who had been prospectively identified in the transition clinic and adult urology clinic since 2014. Demographic and clinical data were collected and analyzed to determine patient adherence with transfer of care, to study long-term compliance with follow-up, and to identify factors that positively and negatively influenced transition clinic success. RESULTS 157 patients participated in the transition clinic. 76/79 (96.2%) patients ready to transition successfully transferred to adult care. 55/76 (72.4%) remain active. Greater number of visits between transition stages was significant among patients who maintained active follow-up after transition (P = .006). 171 patients initiated care in our adult urology clinic without transition. Irrespective of nontransitioned patients longer follow-up, formally transitioned adult patients had higher yearly participation rates, with 55 (72.4%) transitioned patients compared to 63 (36.8%) nontransitioned patients remaining active (P < .001). CONCLUSION Congenital neurogenic bladder patients who participated in a transition clinic were successful transferring from pediatric to adult care, with improved clinic adherence in adulthood, compared to patients who initiated adult care without structured transition. Early introduction to adult providers and increased number of visits positively impacted adherence upon transition to adult care. Noncompliance with pediatric provider visits negatively impacted transition adherence.
Collapse
Affiliation(s)
- Aleksandar Blubaum
- Department of Urology, OU Health University of Oklahoma Medical Center, Oklahoma City, OK
| | - Jennifer Lewis
- Department of Urology, OU Health University of Oklahoma Medical Center, Oklahoma City, OK
| | - Dominic Frimberger
- Department of Pediatric Urology, Oklahoma Children's Hospital OU Health, Oklahoma City, OK
| | - Gennady Slobodov
- Department of Urology, OU Health University of Oklahoma Medical Center, Oklahoma City, OK.
| |
Collapse
|
3
|
Fremion E, Kaufman M, Mukherjee S, Murphy P, Smith K. 2023 updates to the spina bifida transition to adult care guidelines. J Pediatr Rehabil Med 2023; 16:583-593. [PMID: 38160373 PMCID: PMC10789338 DOI: 10.3233/prm-230052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE This article provides an update to the 2018 Spina Bifida Association's Transition to Adult Care Guidelines. METHODS A workgroup of topic experts was convened including authors from the initial guideline workgroup. The workgroup reviewed and updated the primary, secondary, and tertiary outcome goals, clinical questions, and guideline recommendations based on a literature review. RESULTS Twenty-two additional articles were identified from the literature search. Updated references included observational studies describing transition to adult care outcomes, transition care model initiatives, and a validated self-management assessment tool. CONCLUSION Structured transition initiatives increase the likelihood of establishing with adult care, decrease acute care use for young adults with spina bifida, and have the potential to improve quality of life and optimize chronic condition management. However, there is still a need to implement structure transition practices more broadly for this population using these recommended guidelines.
Collapse
Affiliation(s)
- Ellen Fremion
- Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Melissa Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shubhra Mukherjee
- Department of Physical Medicine and Rehabilitation, Shriners Children’s Chicago, Chicago, IL, USA
| | - Pamela Murphy
- District Medical Group Children’s Rehabilitative Services, Phoenix, AZ, USA
| | - Katherine Smith
- Department of Clinical Pediatrics, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
4
|
Kuhn EN, Hopson B, Shamblin I, Maleknia PD, Rocque BG. Telemedicine and Spina Bifida Transition: A Pilot Randomized Trial. World Neurosurg 2022; 167:e1455-e1460. [PMID: 36156308 DOI: 10.1016/j.wneu.2022.09.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Transition of care is the planned movement of adolescents and young adults from pediatric to adult health care. Many studies have demonstrated the importance of an organized transition process. The purpose of this study is to determine the efficacy of a telemedicine intervention for improving transition readiness among adolescents with spina bifida. METHODS The present study is a randomized, controlled trial, including children 14 years of age and older with myelomeningocele from a multidisciplinary spina bifida clinic. Subjects were randomized to standard care or to an intervention, consisting of video telemedicine contacts at 3, 6, and 9 months from the clinic visit. The primary outcome measure was a change in the Transition Readiness Assessment Questionnaire score from baseline to 1-year follow-up. RESULTS Twenty-four patients were enrolled in the study and underwent randomization. The mean age at enrollment was 15.8 years. Ten patients (40%) were female, and the majority were White, non-Hispanic (67%). Despite enrolling 24 patients, only 1 patient in the telemedicine group completed any of the planned telemedicine sessions. No other participant completed any telemedicine counseling sessions. The study was stopped early for lack of participation in the intervention. In a single-group, as-treated analysis, there was no significant change in the Transition Readiness Assessment Questionnaire score between enrollment and 1-year follow-up (Δ = 0.36, P = 0.46). However, there were significant improvements in subscores for Managing Medications, Appointment Keeping, and Managing Daily Activities. CONCLUSIONS The primary finding from this study was very low participation in a telemedicine video follow-up intervention among adolescents with myelomeningocele. Based on these results, this strategy alone is unlikely to significantly improve readiness for transition to adult care.
Collapse
Affiliation(s)
- Elizabeth N Kuhn
- Department of Neurosurgery and Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Betsy Hopson
- Department of Neurosurgery and Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Isaac Shamblin
- Department of Neurosurgery and Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pedram Daniel Maleknia
- Department of Neurosurgery and Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brandon G Rocque
- Department of Neurosurgery and Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| |
Collapse
|
5
|
Groskaufmanis L, Lin P, Kamdar N, Khan A, Peterson MD, Meade M, Mahmoudi E. Racial and Ethnic Inequities in Use of Preventive Services Among Privately Insured Adults With a Pediatric-Onset Disability. Ann Fam Med 2022; 20:430-437. [PMID: 36228076 PMCID: PMC9512552 DOI: 10.1370/afm.2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Cerebral palsy (CP) and spina bifida (SB) are pediatric-onset disabilities. Adults living with CP/SB are in a greater need of preventive care than the general population due to their increased risk for chronic diseases. Our objective was to compare White/Black and White/Hispanic inequities in the use of preventive services. METHODS Using 2007-2017 private claims data, we identified a total of 11,635 adults with CP/BS. Of these, 8,935 were White, 1,457 Black, and 1,243 Hispanic. We matched health-related variables (age, sex, comorbid conditions) between White adults and those in each minority subpopulation. Generalized estimating equations were used and all models were adjusted for age, sex, comorbidities, income, education, and US Census divisions. Outcomes of interest were: (1) any office visit; (2) any physical/occupational therapy; (3) wellness visit; (4) bone density screening; (5) cholesterol screening; and (6) diabetes screening. RESULTS The rate of recommended services for all subpopulations of adults with CP/SB was low. Compared with White adults, Hispanic adults had lower odds of wellness visits (odds ratio [OR] = 0.71, 95% CI, 0.53-0.96) but higher odds of diabetes screening (OR = 1.48, 95% CI, 1.13-1.93). Compared with White adults, Black adults had lower odds of wellness visits (OR = 0.50, 95% CI, 0.24-1.00) and bone density screening (OR = 0.54, 95% CI, 0.31-0.95). CONCLUSIONS Preventive service use among adults with CP/SB was low. Large White-minority disparities in wellness visits were observed. Interventions to address physical accessibility, adoption of telehealth, and increased clinician education may mitigate these disparities, particularly if initiatives target minority populations.
Collapse
Affiliation(s)
- Lauren Groskaufmanis
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Anam Khan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Mark D Peterson
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michelle Meade
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan .,Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
6
|
Neurogenic Bladder:. Urol Clin North Am 2022; 49:519-532. [DOI: 10.1016/j.ucl.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
7
|
Petronic Markovic I, Nikolic D, Stahl M, Tederko P, Hdyrya O, Negrini S, Zampolini M, Kiekens C. Evidence-based position paper of the UEMS PRM on the role of Physical and Rehabilitation Medicine (PRM) physician in the management of children and adults with spinal dysraphism. Eur J Phys Rehabil Med 2022; 58:511-519. [PMID: 35575455 PMCID: PMC9980507 DOI: 10.23736/s1973-9087.22.07536-0] [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: 11/08/2022]
Abstract
Spinal dysraphism (SD) or spina bifida (SB) is a congenital deformity that results from embryonic neural tube closure failure during fetal development. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. This paper aims to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for children and adults with spinal dysraphism. A systematic literature review and a consensus procedure involved all European countries delegates represented in the UEMS PRM section through a Delphi process. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The professional role of the PRM physician requires specific expertise in the treatment of patients with SD to plan, lead and monitor the rehabilitation process in an interdisciplinary setting and to participate in the assessment of the needs of these patients in the transitional phase from childhood to adulthood, with particular attention to the activity limitation and participation restriction.
Collapse
Affiliation(s)
- Ivana Petronic Markovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia - .,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - Minna Stahl
- National Center for Pediatric and Adolescent Pain Management and Research, New Children's Hospital, HUS, Helsinki, Finland
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Oksana Hdyrya
- Department of Rehabilitation and Alternative Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Stefano Negrini
- La Statale University, Milan, Italy.,IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Mauro Zampolini
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | | |
Collapse
|
8
|
Gober J, Thomas SP, Gater DR. Pediatric Spina Bifida and Spinal Cord Injury. J Pers Med 2022; 12:jpm12060985. [PMID: 35743769 PMCID: PMC9225638 DOI: 10.3390/jpm12060985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022] Open
Abstract
Pediatric spina bifida (SB) and spinal cord injury (SCI) are unfortunately common in our society, and their unique findings and comorbidities warrant special consideration. This manuscript will discuss the epidemiology, pathophysiology, prevention, and management strategies for children growing and developing with these unique neuromuscular disorders. Growth and development of the maturing child places them at high risk of spinal cord tethering, syringomyelia, ascending paralysis, pressure injuries, and orthopedic abnormalities that must be addressed frequently and judiciously. Similarly, proper neurogenic bladder and neurogenic bowel management is essential not just for medical safety, but also for optimal psychosocial integration into the child’s expanding social circle.
Collapse
Affiliation(s)
- Joslyn Gober
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
- The Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- Correspondence:
| | - Sruthi P. Thomas
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
- The Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| |
Collapse
|
9
|
Jefferies M, Peart T, Perrier L, Lauzon A, Munce S. Psychological Interventions for Individuals With Acquired Brain Injury, Cerebral Palsy, and Spina Bifida: A Scoping Review. Front Pediatr 2022; 10:782104. [PMID: 35386256 PMCID: PMC8978581 DOI: 10.3389/fped.2022.782104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND With current medical advancements, more adolescents with neurodevelopmental disorders are transitioning from child- to adult-centred health care services. Therefore, there is an increasing demand for transitional services to help navigate this transition. Health care transitions can be further complicated by mental health challenges prevalent among individuals with cerebral palsy (CP), spina bifida (SB), and childhood onset acquired brain injury (ABI). Offering evidence-based psychological interventions for these populations may improve overall outcomes during transition period(s) and beyond. The objective of this scoping review is to identify key characteristics of psychological interventions being used to treat the mental health challenges of adolescents and adults with CP, SB, and childhood onset ABI. METHODS Methodological frameworks by Arksey and O'Malley, and Levac and colleagues were used to explore studies published between 2009 and 2019. Included studies were required to be written in English and report on a psychological intervention(s) administered to individuals at least 12 years of age with a diagnosis of CP, SB, or childhood onset ABI. All study designs were included. RESULTS A total of 11 studies were identified. Of these, eight reported psychological interventions for childhood onset ABI, while three reported on CP. No studies reporting on SB were identified. Commonly used interventions included acceptance and commitment therapy (ACT), psychotherapy, and cognitive behavioral therapy (CBT). CONCLUSIONS There are a limited number of studies investigating psychological interventions for individuals with childhood onset ABI and CP, and none for individuals with SB. Further research into effective psychological interventions for these populations will improve mental health outcomes and transitional services.
Collapse
Affiliation(s)
- Morgan Jefferies
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Taylor Peart
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Andrea Lauzon
- LIFESpan Service, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,LIFESpan Service, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,LIFESpan Service, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| |
Collapse
|
10
|
Basu T, Kamdar N, Brady P, Cole CM, King J, Rontal R, Harper DM. Annual Wellness Visits for Persons With Physical Disabilities Before and After ACA Implementation. Ann Fam Med 2021; 19:484-491. [PMID: 34518196 PMCID: PMC8575518 DOI: 10.1370/afm.2712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Persons with disabilities often experience uncoordinated health care, with repeated out-of-pocket copays. One purpose of the Patient Protection and Affordable Care Act (ACA) was to create zero copays for preventive health care including an annual wellness visit (AWV). The purpose of this study was to document the use of AWVs by persons with physical disabilities during the ACA rollout. METHODS An administrative claims database, including both Medicare Advantage (MA) and commercial (COM) payers from 2008 to 2016, was used to identify unique wellness visits for adults with physical disabilities. We used interrupted time series analysis to compare AWV use by insurance type, sex, disability type, and race over time. RESULTS The proportion of zero copays provided a timeline of ACA implementation categorized as pre-ACA, ACA-implementation, and post-ACA periods. By 2016, AWV use maximized at 47.6% (95% CI, 44.7%-50.8%) among COM-insured White women with congenital disabilities. By 2016, the lowest AWV use reached one-half the maximum, at 21.6% (95% CI, 18.4%-25.2%) among COM-insured Hispanic men with acquired disabilities. MA-insured Black and Hispanic men with acquired disabilities reached similarly low levels of AWV use. CONCLUSION The ACA mandated zero copays, thereby allowing persons with physical disabilities the option for preventive health care without cost. Insurance type and sex significantly influenced AWV use, followed by disability type and race. Gaps in AWV use were exposed by insurance type, sex, disability, and race for persons with disabilities. Gaps in AWV use were also exposed between the general population and persons with disabilities.Annals "Online First" article.
Collapse
Affiliation(s)
- Tanima Basu
- University of Michigan, Institute for Healthcare Policy & Innovation, Ann Arbor, Michigan
| | - Neil Kamdar
- University of Michigan, Institute for Healthcare Policy & Innovation, Ann Arbor, Michigan
| | - Patrick Brady
- University of Michigan, Institute for Healthcare Policy & Innovation, Ann Arbor, Michigan
| | | | - Jaque King
- University of Michigan, Center for Health and Research Transformation, Ann Arbor, Michigan
| | - Robyn Rontal
- University of Michigan, Center for Health and Research Transformation, Ann Arbor, Michigan
| | - Diane M Harper
- University of Michigan, Departments of Family Medicine, Obstetrics/Gynecology, Bioengineering, Women's & Gender Studies, IHPI, Ann Arbor, Michigan
| |
Collapse
|
11
|
SHOWEN AMYE, COPP HILLARYL, ALLEN ISABELE, HAMPSON LINDSAYA. Resilience and associated characteristics in adults with spina bifida. Dev Med Child Neurol 2021; 63:1229-1235. [PMID: 33987844 PMCID: PMC8429202 DOI: 10.1111/dmcn.14919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 01/13/2023]
Abstract
AIM To measure resilience and identify associated demographic and clinical factors in individuals with spina bifida. METHOD An anonymous survey was distributed via Facebook advertising to individuals with congenital urological conditions. Respondents 18 years or older with spina bifida were included in this study. Resilience was measured with the 10-item Connor-Davidson Resilience Scale. Mean resilience levels in the study population and a US general population sample were compared with Student's t-test. Multiple linear regression assessed demographic and clinical factors associated with resilience. RESULTS The mean resilience score for participants (n=195; 49 males, 146 females; mean age 40y 2mo [SD 12y 7mo] range 18-74y) was 27.2 (SD 7.5), which differed from a mean of 31.8 (SD 5.4) for a US general population sample (p<0.01). Multiple linear regression demonstrated significant positive associations between resilience and older age (p=0.04), prior urological surgeries (p=0.03), higher household education (p<0.01), and higher physical function (p<0.01). INTERPRETATION Resilience in individuals with spina bifida is moderately poor, relative to the general population, and is associated with certain demographic and clinical factors. As a modifiable construct with positive effects on quality of life, psychological well-being, and health-related behaviors, resilience is a promising target for intervention in individuals with spina bifida. What this paper adds Resilience in individuals with spina bifida is moderately poor. Resilience is lower in individuals with spina bifida than the general population. Resilience is associated with age, household education, physical function, and urological surgery.
Collapse
Affiliation(s)
- AMY E SHOWEN
- Department of Pediatrics, University of California, San Francisco, California
| | - HILLARY L COPP
- Department of Urology, University of California, San Francisco, California
| | - ISABEL E ALLEN
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - LINDSAY A HAMPSON
- Department of Urology, University of California, San Francisco, California
| |
Collapse
|
12
|
Loftus CJ, Ahn J, Hagedorn JC, Cain M, Holt S, Merguerian P, Shnorhavorian M. The impact of the dependent care provision on individuals with spina bifida transitioning to adulthood. J Pediatr Urol 2021; 17:289.e1-289.e9. [PMID: 33563555 DOI: 10.1016/j.jpurol.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Under the Affordable Care Act, the Dependent Care Provision (DCP) was enacted in 2010 and expanded healthcare coverage for millions of young adults ages 19-25 by allowing them to stay on their parents' insurance until age 26. It is unknown whether the DCP has impacted young adults with SB who are at risk for lapses in insurance coverage as they transition into adult care. OBJECTIVE Our aim was to determine the impact of the DCP on access to care (insurance status) and healthcare-quality (hospital admissions for potentially preventable conditions). METHODS Using the National Inpatient Sample (an all-payor national dataset of hospital admissions), we analyzed pre/post DCP changes for admissions of SB patients ages 19-25. Our outcomes of interest were rates of insurance coverage and proportion of admissions due to potentially preventable conditions (UTI, pyelonephritis, skin conditions, osteomyelitis, sepsis, and pneumonia). Analysis included a difference-in-differences logistic regression model which compared the pre/post DCP difference (2006-s quarter of 2010 vs. 2011-2013) in patients ages 19-25 to the difference in patients ages 26-32 who were ineligible for the DCP policy. RESULTS For admissions of SB patients ages 19-25, the DCP was not associated with improved insurance status compared to admissions ages 26-32 (0% vs. -0.4%, p = 0.10) and rates of private insurance decreased in both age groups, but more so in ages 26-32 (-2.0% vs. -3.9%, p < 0.001). Private insurance rates increased for admissions of white patients ages 19-25 but not for black and Hispanic groups. An increase in overall insurance status was also seen in young adults from high-income zip codes. Admissions for potentially preventable conditions increased in both age groups by a similar degree (+2.6% vs. +2.5%, p = 0.82). DISCUSSION Under the Affordable Care Act, the DCP failed to improve rates of private insurance or decrease rates of noninsurance for admissions of young adults with SB. Certain race and socioeconomic groups benefited more from this national healthcare policy. Meanwhile, admissions for potentially preventable conditions are common in spina bifida patients, and increased over the study period, suggesting a need for further investigation into optimizing the delivery of healthcare to this complex patient population. CONCLUSION The DCP did not result in improved overall insurance rates or in improved rates of private insurance for admissions of SB patients 18-25 years old.
Collapse
Affiliation(s)
- Christopher J Loftus
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA.
| | - Jennifer Ahn
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Judith C Hagedorn
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA
| | - Mark Cain
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Sarah Holt
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA
| | - Paul Merguerian
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Margarett Shnorhavorian
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| |
Collapse
|
13
|
Jasien JM, Mikati MA, Kolarova M, Smith B, Thera S, Lee P. Cognitive and motor function in adults with spina bifida myelomeningocele: a pilot study. Childs Nerv Syst 2021; 37:1143-1150. [PMID: 33185713 PMCID: PMC8012220 DOI: 10.1007/s00381-020-04964-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Determine the feasibility and utility of using a battery of tests utilized, so far, to assess neurological-cognitive functions in the typical adult population and identify the spectrum of these functions in adult SBM patients. METHODS Prospective study in which 15 participants (mean age = 28.7 ± 8.7 years, range = 19-45 years) completed the targeted battery of tests (n = 5-15/test) previously standardized to the general population. Results were compared with normative data. RESULTS Statistically significant differences with normative means were noted in the following tests: Montreal Cognitive Assessment (MoCA), Functional Activities Questionnaire (FAQ), and NIH Toolbox Fine Motor (Dexterity and Grip Strength) tests. Cohort means for NIH Toolbox Fluid, Crystallized, and Cognitive Composite Scores and Timed Up and GO (TUG) were not different from normative means. CONCLUSION All tests were successfully completed by cohort. Whereas many aspects of cognition were normal, tests assessing visual-constructural, calculation, motor, and fluency functions did show differences from population means. Numerous tests assessing multiple domains are needed and can be used in future aging studies to appreciate the spectrum of cognitive and motor abilities in adults with SBM.
Collapse
Affiliation(s)
- Joan Mary Jasien
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA.
| | - Mohamad A. Mikati
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | | | - Brian Smith
- Division of Neonatal-Perinatal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Stephanie Thera
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, Duke University, Durham, NC, USA
| | - Pierre Lee
- Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
14
|
Peterson MD, Lin P, Kamdar N, Mahmoudi E, Marsack-Topolewski CN, Haapala H, Muraszko K. Psychological morbidity among adults with cerebral palsy and spina bifida. Psychol Med 2021; 51:694-701. [PMID: 32713401 PMCID: PMC9650963 DOI: 10.1017/s0033291720001981] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Very little is known about the risk of developing psychological morbidities among adults living with cerebral palsy (CP) or spina bifida (SB). The objective of this study was to compare the incidence of and adjusted hazards for psychological morbidities among adults with and without CP or SB. METHODS Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth revision, Clinical Modification diagnostic code for CP or SB (n = 15 302). Adults without CP or SB were also included (n = 1 935 480). Incidence estimates of common psychological morbidities were compared at 4-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities. RESULTS Adults living with CP or SB had a higher 4-year incidence of any psychological morbidity (38.8% v. 24.2%) as compared to adults without CP or SB, and differences were to a clinically meaningful extent. Fully adjusted survival models demonstrated that adults with CP or SB had a greater hazard for any psychological morbidity [hazard ratio (HR): 1.60; 95% CI 1.55-1.65], and all but one psychological disorder (alcohol-related disorders), and ranged from HR: 1.32 (1.23, 1.42) for substance disorders, to HR: 4.12 (3.24, 5.25) for impulse control disorders. CONCLUSIONS Adults with CP or SB have a significantly higher incidence of and risk for common psychological morbidities, as compared to adults without CP or SB. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce the risk of disease onset/progression in these higher-risk populations.
Collapse
Affiliation(s)
- Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan
- Department of Emergency Medicine, Michigan Medicine, University of Michigan
- Department of Surgery, Michigan Medicine, University of Michigan
| | - Elham Mahmoudi
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Family Medicine, Michigan Medicine, University of Michigan
| | | | - Heidi Haapala
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karin Muraszko
- Department of Neurosurgery, Michigan Medicine, University of Michigan
| |
Collapse
|
15
|
Tomei KL, Zhou X. Transition of Care of the Spina Bifida Patient from Childhood to Adulthood. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1715498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractSpina bifida is a complex disease process, the care of which involves multiple physicians and other healthcare providers in several disciplines. As our treatment of this disorder has improved over time, thus has survival of these patients into adulthood. Consideration in the care of young adults and adults with spina bifida poses significant challenges that parallel many other disease processes of childhood where medical advances have improved survival. We attempt to discuss the complex disorder that is spina bifida and some of the challenges associated with transition of care of these patients into adulthood.
Collapse
Affiliation(s)
- Krystal L Tomei
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Xiaofei Zhou
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| |
Collapse
|
16
|
Cools M, Northam W, Goodnight W, Mulvaney G, Elton S, Quinsey C. Thirty-day medical and surgical readmission following prenatal versus postnatal myelomeningocele repair. Neurosurg Focus 2020; 47:E14. [PMID: 31574468 DOI: 10.3171/2019.7.focus19355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hospital readmission is an important quality metric that has not been evaluated in prenatal versus postnatal myelomeningocele (MMC) repair. This study compares hospital readmission outcomes between these two groups as well as their etiologies. METHODS The medical records of patients who had undergone MMC repair in the period from 2011 to 2017 at a single academic medical center were retrospectively reviewed. Collected clinical data included surgery and defect details, neonatal intensive care unit (NICU) stay, and any readmissions or surgical procedures up to 1 year after surgery. Patient and defect characteristics, readmission outcomes at 30 and 60 days and 1 year after discharge from the NICU, and cerebrospinal fluid (CSF) diversion surgery rates were analyzed with the two-tailed t-test and/or k-sample test on the equality of medians. RESULTS A total of 24 prenatal and 34 postnatal MMC repairs were completed during the study period. Prenatally repaired patients were born more prematurely (p < 0.001) and with lower birth weights (p < 0.001), although the NICU stay was similar between the two groups (p = 0.59). Fewer prenatally repaired patients were readmitted at 30 days (p = 0.005), 90 days (p = 0.004), and 1 year (p = 0.007) than the postnatal repair group. Hydrocephalus was the most common readmission etiology, and 29% of prenatal repair patients required CSF diversion at 1 year versus 81% of the postnatal repair group (p < 0.01). Prenatal patients who required CSF diversion had a higher body weight (p = 0.02) and an older age (p = 0.01) at the time of CSF diversion surgery than the postnatal group. CONCLUSIONS Patients with prenatal MMC repair had fewer hospital readmissions at 30 days, 60 days, and 1 year than the postnatal repair group, despite similar NICU lengths of stay. The prenatal repair group had lower requirements for CSF diversion at 1 year and was older with greater body weights at the time of CSF diversion surgery, compared to those of the postnatal repair group. Future study of hospital quality metrics such as readmissions should be performed to better understand outcomes of these two procedures.
Collapse
Affiliation(s)
- Michael Cools
- 1Department of Neurosurgery, University of North Carolina School of Medicine
| | - Weston Northam
- 1Department of Neurosurgery, University of North Carolina School of Medicine
| | - William Goodnight
- 2Maternal Fetal Care Program, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill; and
| | - Graham Mulvaney
- 3Carolina Neurosurgery and Spine Associates, Carolinas Medical Center, Charlotte, North Carolina
| | - Scott Elton
- 1Department of Neurosurgery, University of North Carolina School of Medicine
| | - Carolyn Quinsey
- 1Department of Neurosurgery, University of North Carolina School of Medicine
| |
Collapse
|
17
|
Le HK, Cardona-Grau D, Chiang G. Evaluation and Long-term Management of Neurogenic Bladder in Spinal Dysraphism. Neoreviews 2020; 20:e711-e724. [PMID: 31792158 DOI: 10.1542/neo.20-12-e711] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Spinal dysraphism, which includes conditions such as myelomeningocele and sacral agenesis, is one of the most common causes of congenital lower urinary tract dysfunction. Early evaluation of the neurogenic bladder serves to minimize renal damage, and the main goals of management include preserving renal function, achieving acceptable continence, and optimizing quality of life. The survival of patients with such conditions has improved to greater than 80% reaching adulthood, owing to advances in diagnostic and therapeutic modalities. The result is a real, and unfortunately often unmet, need for successful transitional care in this complex patient population. Clinicians must be able to identify the unique challenges encountered by patients with neurogenic bladder as they shift through different stages of their life.
Collapse
Affiliation(s)
- Hoang-Kim Le
- Division of Pediatric Urology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| | | | - George Chiang
- Division of Pediatric Urology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| |
Collapse
|
18
|
McPherson AC, Chen L, O'Neil J, Vanderbom KA. Nutrition, metabolic syndrome, and obesity: Guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:637-653. [PMID: 33325412 PMCID: PMC7838992 DOI: 10.3233/prm-200753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Nutritional challenges and a lack of activity can lead to health problems across the lifespan for people with spina bifida. Children and adults with spina bifida are also at greater risk of being classified as overweight or obese compared to their peers without the condition. Therefore, early recognition of nutrition problems, weight management counseling, and timely referrals for evaluation and management of diet and activity can help those with spina bifida and their families achieve a healthy lifestyle. This article details the development of the Nutrition, Metabolic Syndrome and Obesity Guidelines, which are part of the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida. It discusses the identification and management of poor nutrition and prevention of obesity for children, adolescents, and adults with spina bifida and highlights areas requiring further research.
Collapse
Affiliation(s)
- Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Lorry Chen
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Joseph O'Neil
- Indiana University School of Medicine, Riley Hospital for Children Indiana University Health, Indianapolis, IN, USA
| | - Kerri A Vanderbom
- National Center on Health, Physical Activity and Disability, University of Alabama at Birmingham/Lakeshore Research Collaborative, Birmingham, AL, USA
| |
Collapse
|
19
|
Early Vs. Expectant Management of Spina Bifida Patients-Are We All Talking About a Risk Stratified Approach? Curr Urol Rep 2019; 20:76. [PMID: 31734847 DOI: 10.1007/s11934-019-0943-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Advancements in the care of patients affected by myelomeningocele have flourished in recent years especially with respect to renal preservation and continence. Involvement of urologists both prenatally and early in life has driven many developments in preventative care and early intervention. As of yet, however, the ideal management algorithm that offers these patients the least invasive diagnostic testing and interventions while still preserving renal and bladder function remains ill defined. RECENT FINDINGS In a shift from prior years where the use of surgical intervention and intermittent catheterization were more liberally employed, some providers have more recently advocated for monitoring patients in a more conservative manner with a variety of diagnostic tests until radiographic or clinical changes are discovered. The criteria used to define the need for catheterization and the timing to initiate CIC or more invasive interventions is disparate across pediatric urology and there is published data to support several approaches. This review presents some of these criteria for use of CIC and some newer evidence to support different approaches along with supporting the trend toward individualized medicine and use of risk stratification in developing clinical treatment algorithms.
Collapse
|
20
|
Kessler BA, Catalino MP, Quinsey C, Goodnight W, Elton S. Cost of prenatal versus postnatal myelomeningocele closure for both mother and child at 1 year of life. Neurosurg Focus 2019; 47:E15. [PMID: 31574469 DOI: 10.3171/2019.7.focus19417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prenatal myelomeningocele (MMC) closure has been performed in the United States for 2 decades. While prior work has focused on clinical outcomes of prenatal MMC closure, the cost of this procedure in comparison with that of postnatal MMC closure is unclear. The authors' aim was to compare the cost of prenatal versus postnatal MMC closure for both the child and mother at 1 year. METHODS A prospective database of patients undergoing prenatal and postnatal MMC closure between 2011 and 2018 with 1-year follow-up was retrospectively reviewed. Charge data for relevant admissions were converted to a cost estimate using the authors' institution's Medicare hospital-specific cost-to-charge ratio. Children, mothers, and mother/child pairs were considered separately. The primary outcome was cost. Secondary outcomes included the need for hydrocephalus treatment, length of stay (LOS), and readmissions. Other covariates included gestational age at birth, MMC lesion level, and obstetric complications. RESULTS The median cost of care for children in the prenatal group was greater, although not significantly so, at $58,406.71 (IQR $16,900.24-$88,951.01) compared with $49,889.95 (IQR $38,425.18-$115,163.86) for children in the postnatal group (p = 0.204). The median cost for mothers in the prenatal group was significantly greater at $24,548.29 (IQR $20,231.55-$36,862.31) compared with $5087.30 (IQR $4430.72-$5362.56) (p < 0.001). The median cost for mother/child pairs in the prenatal group was $102,377.75 (IQR $37,384.30-$118,527.74) compared with $55,667.82 (IQR $42,840.78-$120,058.06) (p = 0.45). Children in the prenatal group had a lower gestational age at birth (235.81 days vs 265.77 days, p < 0.001) and fewer readmissions (33.3% vs 72.7%, p < 0.001), and hydrocephalus treatment was less common (33.3% vs 90.9%, p < 0.001). Index LOS did not differ between children in the prenatal and postnatal groups (26.8 days vs 23.5 days, p = 0.63). Mothers in the prenatal group had longer LOS (15.92 days vs 4.68 days, p < 0.001) and more readmissions (18.5% vs 0.0%, p = 0.06). CONCLUSIONS The median cost of prenatal versus postnatal MMC closure did not significantly differ from a hospital perspective at 1 year, although variability in cost was high for both groups. When considering the mother alone, prenatal MMC closure was costlier. Future work is needed to assess cost from a patient and societal perspective both at 1 year and beyond.
Collapse
Affiliation(s)
| | | | | | - William Goodnight
- 2Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | |
Collapse
|