Abstract：
OBJECTIVE: To investigate potential differences in new patient appointment wait times for otolaryngology care based on insurance types and explore factors influencing these wait times.
METHODS: A cross-sectional audit study, using a \"mystery caller\" approach, analyzed with a linear mixed Poisson model to adjust for confounding factors.
METHODS: A total of 612 physicians across 49 states and the District of Columbia, representing 6 otolaryngology subspecialties, were included.
METHODS: Otolaryngology physicians were contacted by mystery callers via telephone with scripted clinical vignettes as patients with either Medicaid or Blue Cross/Blue Shield (BCBS) insurance. Callers requested next available appointment. Wait times for new patient appointments were recorded and analyzed in R using a generalized linear mixed Poisson model.
RESULTS: A total of 1183 of 1224 calls reached a representative. Medicaid patients waited 5.73% longer (P < .001) compared to BCBS patients (IRR: 1.06; confidence interval [CI]: 1.03-1.09; P < .001), with respective mean wait times of 36.8 days (SE ± 1.6) and 32.4 days (SE ± 1.6). Longer waiting times were also associated with physicians affiliated with universities (P = .001) and certain subspecialties, such as pediatric otolaryngology (P < .001) and neurotology (P = .008). Regional differences were also observed, with specific AAO-HNS regions showing shorter wait times. The model achieved a conditional R-squared value of 0.947.
CONCLUSIONS: This study reveals disparities in wait times for otolaryngology care based on insurance type, with extended wait times for Medicaid beneficiaries. The findings highlight a potential access to care disparity, which begets the need for strategies that ensure equitable access to otolaryngology care and further research to understand the underlying reasons for these potential disparities.
METHODS: A cross-sectional audit study, using a \"mystery caller\" approach, analyzed with a linear mixed Poisson model to adjust for confounding factors.
METHODS: A total of 612 physicians across 49 states and the District of Columbia, representing 6 otolaryngology subspecialties, were included.
METHODS: Otolaryngology physicians were contacted by mystery callers via telephone with scripted clinical vignettes as patients with either Medicaid or Blue Cross/Blue Shield (BCBS) insurance. Callers requested next available appointment. Wait times for new patient appointments were recorded and analyzed in R using a generalized linear mixed Poisson model.
RESULTS: A total of 1183 of 1224 calls reached a representative. Medicaid patients waited 5.73% longer (P < .001) compared to BCBS patients (IRR: 1.06; confidence interval [CI]: 1.03-1.09; P < .001), with respective mean wait times of 36.8 days (SE ± 1.6) and 32.4 days (SE ± 1.6). Longer waiting times were also associated with physicians affiliated with universities (P = .001) and certain subspecialties, such as pediatric otolaryngology (P < .001) and neurotology (P = .008). Regional differences were also observed, with specific AAO-HNS regions showing shorter wait times. The model achieved a conditional R-squared value of 0.947.
CONCLUSIONS: This study reveals disparities in wait times for otolaryngology care based on insurance type, with extended wait times for Medicaid beneficiaries. The findings highlight a potential access to care disparity, which begets the need for strategies that ensure equitable access to otolaryngology care and further research to understand the underlying reasons for these potential disparities.
摘要：
目的：调查基于保险类型的耳鼻喉科护理新患者预约等待时间的潜在差异，并探讨影响这些等待时间的因素。
方法：横断面审计研究，使用“神秘来电者”的方法，用线性混合泊松模型进行分析，以调整混杂因素。
方法：共有来自49个州和哥伦比亚特区的612名医生，代表6个耳鼻喉科亚专科，包括在内。
方法：神秘来电者通过电话联系了耳鼻喉科医生，他们有医疗补助或蓝十字/蓝盾（BCBS）保险的患者。来电者要求下一个可用的约会。使用广义线性混合泊松模型在R中记录并分析新患者预约的等待时间。
结果：共有1224个电话中的1183个到达代表。与BCBS患者相比，医疗补助患者的等待时间延长了5.73％（P<.001）（IRR：1.06；置信区间[CI]：1.03-1.09；P<.001），平均等待时间分别为36.8天(SE±1.6)和32.4天(SE±1.6)。等待时间较长也与附属于大学（P=.001）和某些亚专科的医生有关，如小儿耳鼻喉科（P<.001）和神经科（P=.008）。还观察到区域差异，特定的AAO-HNS区域显示较短的等待时间。该模型实现了0.947的条件R平方值。
结论：这项研究揭示了基于保险类型的耳鼻喉科护理等待时间的差异，延长医疗补助受益人的等待时间。这些发现强调了潜在的护理差距，这就需要确保公平获得耳鼻喉科护理的策略，并进一步研究以了解这些潜在差异的根本原因。
方法：横断面审计研究，使用“神秘来电者”的方法，用线性混合泊松模型进行分析，以调整混杂因素。
方法：共有来自49个州和哥伦比亚特区的612名医生，代表6个耳鼻喉科亚专科，包括在内。
方法：神秘来电者通过电话联系了耳鼻喉科医生，他们有医疗补助或蓝十字/蓝盾（BCBS）保险的患者。来电者要求下一个可用的约会。使用广义线性混合泊松模型在R中记录并分析新患者预约的等待时间。
结果：共有1224个电话中的1183个到达代表。与BCBS患者相比，医疗补助患者的等待时间延长了5.73％（P<.001）（IRR：1.06；置信区间[CI]：1.03-1.09；P<.001），平均等待时间分别为36.8天(SE±1.6)和32.4天(SE±1.6)。等待时间较长也与附属于大学（P=.001）和某些亚专科的医生有关，如小儿耳鼻喉科（P<.001）和神经科（P=.008）。还观察到区域差异，特定的AAO-HNS区域显示较短的等待时间。该模型实现了0.947的条件R平方值。
结论：这项研究揭示了基于保险类型的耳鼻喉科护理等待时间的差异，延长医疗补助受益人的等待时间。这些发现强调了潜在的护理差距，这就需要确保公平获得耳鼻喉科护理的策略，并进一步研究以了解这些潜在差异的根本原因。
