Evaluation of Social Determinants of Health on Dysphagia Care Pathways at a Tertiary Care Facility. Laryngoscope 2024 Mar;134(3):1139-1146
Date
09/08/2023Pubmed ID
37681733DOI
10.1002/lary.31040Scopus ID
2-s2.0-85170398108 (requires institutional sign-in at Scopus site)Abstract
OBJECTIVES: Limited research exists evaluating the impact of social determinants of health in influencing care pathways for patients with dysphagia. A better understanding of whether these determinants correlate to altered care and resource utilization is essential as it relates to patient outcomes.
STUDY DESIGN: Retrospective chart review.
METHODS: All adult patients seen at a tertiary midwestern hospital were screened for ICD codes of dysphagia diagnoses from 2009 to 2019. Demographic information was collected from these patients with dysphagia including sex, race, ethnicity, and insurance status. Subgroup analysis was performed to assess referral pattern rates and types of diagnostic interventions ordered (none, videofluoroscopic swallow study, esophagram, and esophagogastroduodenoscopy).
RESULTS: A total of 31,858 patients with dysphagia were seen at our institution during the study period, with a majority being female (56.36%), Caucasian (79.83%), and publicly insured (63.16%), at a median age of 60.35 years. There were no significant care delivery pattern differences based on geography/zip code analyses. African American patients were significantly more likely to have imaging or interventions performed (odds ratio [OR] 1.463, p = 0.005). Patients with public insurance also had higher rates of diagnostic study utilization (OR 1.53, p = 0.01). Only 3% of all patients with dysphagia were seen by laryngologists.
CONCLUSION: No significant differences were seen in dysphagia evaluation modalities based on zip code analyses surrounding this tertiary care facility. African American patients and those with public insurance had significantly higher utilization of subsequent testing and intervention for dysphagia care. Further studies are necessary to delineate causes and outcome differences for these measurable differences in dysphagia care pathways.
LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1139-1146, 2024.
Author List
Zagloul MM, Bock JM, Blumin JH, Friedland DR, Adams JA, Tong L, Osinksi KI, Khani M, Luo JAuthors
Joel H. Blumin MD Chief, Professor in the Otolaryngology department at Medical College of WisconsinJonathan Bock MD Professor in the Otolaryngology department at Medical College of Wisconsin
David R. Friedland MD Associate Director, Director, Chief, Professor in the Otolaryngology department at Medical College of Wisconsin
Jake Luo Ph.D. Associate Professor; Director, Center for Biomedical Data and Language Processing (BioDLP) in the Health Informatics & Administration department at University of Wisconsin - Milwaukee
MESH terms used to index this publication - Major topics in bold
AdultCritical Pathways
Deglutition Disorders
Female
Humans
Male
Middle Aged
Retrospective Studies
Social Determinants of Health
Tertiary Healthcare
