关键词: Access to care Gait analysis Insurance Social determinants of health

来  源:   DOI:10.1016/j.gaitpost.2024.07.007

Abstract:
BACKGROUND: Comprehensive computerized gait analysis (CGA) alters orthopedic surgical plans and improves outcomes. Despite these documented benefits, CGA is not widely available to all patients who could be helped by it.
OBJECTIVE: Do social determinants of health impact access to CGA?
METHODS: Retrospective review of patients seen for CGA from 2021 to 2022. Dates of referral, insurance approval and completion of CGA, demographics and insurance type were extracted from patient records. Zip codes were used to determine the neighborhood socioeconomic status (SES). Data were analyzed using non-parametric statistics.
RESULTS: Insurance type affected time to authorization (private insurance/self-pay: median 9 days; HMO insurance: median 51.5 days; public insurance: median 27 days; p=0.0004). Once authorized, insurance type did not affect time to schedule and complete CGA (p=0.76). Lower neighborhood SES was associated with longer time to authorization but shorter time to complete CGA once authorized. Rescheduling was associated with longer time to complete CGA once authorized (median 29.5 vs. 16 days, p<0.0001). White, non-Hispanic families tended to reschedule more often than non-white or Hispanic families (35 % vs. 18 %, p=0.07).
CONCLUSIONS: Knowledge of barriers to CGA is necessary in order to design and implement effective strategies to widen its availability to all whom it could benefit. Social determinants of health and insurance type are associated with delays in authorization for CGA. Families with public insurance and HMO coverage experience delays in obtaining insurance authorization compared to PPO/self-pay patients, whose tests did not require prior authorization. However, there can also be delays in scheduling and completing CGA once authorized. This is a multi-faceted issue that requires further research.
摘要:
背景:综合计算机步态分析(CGA)改变了骨科手术计划并改善了预后。尽管有这些记录的好处,CGA并不广泛适用于所有可以得到它帮助的患者。
目标:健康的社会决定因素是否影响获得CGA?
方法:对2021年至2022年CGA患者的回顾性回顾。转诊日期,保险批准和完成CGA,从患者记录中提取人口统计学和保险类型.邮政编码用于确定邻里社会经济地位(SES)。使用非参数统计学分析数据。
结果:保险类型受授权时间影响(私人保险/自付:中位数9天;HMO保险:中位数51.5天;公共保险:中位数27天;p=0.0004)。一旦授权,保险类型不影响计划和完成CGA的时间(p=0.76).较低的邻域SES与较长的授权时间相关,但一旦授权,完成CGA的时间较短。重新安排时间与获得授权后完成CGA的时间更长(中位数29.5vs.16天,p<0.0001)。白色,非西班牙裔家庭比非白人或西班牙裔家庭更倾向于重新安排时间(35%与18%,p=0.07)。
结论:了解CGA的障碍是必要的,以便设计和实施有效的策略,扩大其对所有可能受益的人的可用性。健康和保险类型的社会决定因素与CGA授权的延迟有关。与PPO/自付患者相比,拥有公共保险和HMO保险的家庭在获得保险授权方面会出现延迟,其测试不需要事先授权。然而,一旦授权,安排和完成CGA也可能会延迟。这是一个多方面的问题,需要进一步研究。
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