Evaluation of cost data associated with pediatric cochlear implantation (CI) throughout 2016-2021.

INTRODUCTION: Cochlear Implants (CI) are a mainstay in the treatment of severe sensorineural hearing loss with proven cost-effectiveness and improved quality of life. However, costs associated with CI are variable. During the Covid-19 pandemic, elective surgeries decreased. The investigation into how the pandemic affected CI procedures, costs, and demographic utilization has not been elucidated. METHODS: A retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 50 children's hospitals, was performed. Regions were defined according to PHIS guidelines. We evaluated number of CIs, total charges and costs, Charge to Cost Ratios (CCR), demographic information, and subgrouped this analysis by region throughout 2016-2021. Charges were adjusted by CMS wage index for hospital location. RESULTS: During the years of 2016-2021, there was a rising number of CIs every year except for 2020 which had a decrease, largely driven by the southern and midwestern regions. The median number of cases did not differ between the years. The median adjusted charges increased every year, but not significantly ($103,883-$125,394). The median CCR also did not differ throughout the years (2.7-3.1). Still, there was a larger interquartile range in 2021 (2.3-4.4) for the median CCR compared to all other years (2.1-3.8), particularly in the South. The percentage of white, non-Hispanic/Latino patients who underwent CI was larger in 2020-2021 (78-79.8 %) compared to 2016-2019 (73.3-77.5 %). CONCLUSIONS: The number of CIs in 2020 was lower than in 2019 or 2021. The median CCR for CI procedures increased from 2016 to 2021 but not significantly. The range of CCR was larger in 2021 compared to the years prior, suggestive of cost shifting by some hospitals to offset the loss in revenue. There was a small but significant increase in white, non-Hispanic patients receiving CI in 2020 and 2021, suggestive of a socio-economic shift in care post pandemic.

Impact of COVID-19 on nationwide pediatric otolaryngology practice: Adenotonsillectomies (TA) and tonsil-related diagnoses trends.

OBJECTIVES/HYPOTHESIS: To determine the effects of the COVID-19 pandemic on Adenotonsillectomies (TA), Tonsil Related Cases (TC), and Peritonsillar Abscess (PTA) Trends. STUDY DESIGN: Retrospective Cohort Study. METHODS: This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 51 children's hospitals. Regions were defined according to PHIS rules with at least five children's hospitals per region. We compared monthly total TA, TC, TC as a proportion of all hospital visits, and PTA from all encounters at each hospital from January 1, 2019, through December 31, 2021. RESULTS: Compared to 2019, April 2020 saw mean TC drop significantly from 371.62 to 68.37 (p < 0.001). Interestingly, June, September, and December 2020 had significantly higher mean TC compared to 2019. TC as a proportion of all hospital visits decreased significantly throughout the majority of 2021. Similarly, TA significantly decreased during 2020 and 2021 across all regions in the US, starting in March 2020 and this reduction in TA extended through the end of 2021 without any signs of recovery. PTA rates did not change significantly over the three years. CONCLUSIONS: The pandemic-plagued 2020 saw a noticeable decrease in overall TC and TA but then rebounded quickly to even higher than pre-pandemic levels. However, this rebound halted for the majority of 2021 and subsequently decreased to lower than pre-pandemic levels, which differs from other communicable pathologies such as otitis media which decreased initially then recovered to pre-pandemic levels by Summer of 2021.

Impact of COVID-19 on nationwide pediatric otolaryngology: Otitis media and myringotomy tube trends.

PURPOSE: The pandemic related to the novel coronavirus (COVID-19) has led to a decrease in communicable diseases due to social distancing and mask-wearing. How have the prevalence of otitis media (OM) and its associated procedures changed during the pandemic? STUDY DESIGN: Retrospective Cohort Study. METHODS: This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 48 children's hospitals. Regions were defined according to PHIS rules. We compared proportion of OM to total diagnoses codes, and collected mastoiditis, and MT placements from all encounters through January 1, 2019-June 31, 2021. RESULTS: In April 2020, there was a decrease in mean proportion of OM cases per 100 hospital visits (7 v. 2, p < 0.0001) and this was sustained through 2020 and until June 2021 (6-7 v. 2-4, p < 0.05; p < 0.05). Compared to 2020, the months of April and June 2021 showed an increase in mean proportion of OM cases (6-7 v. 3-4, p < 0.05) while May did not. This relative increase in OM cases through April-June were primarily driven by the South, the Midwest, and the Northeast in April and the South and the Midwest in June. MT procedures followed similar trends. In 2020, there was no difference in mastoiditis as a proportion of OM cases compared to 2019 however there was a statistically higher rate of mastoiditis in 2020 compared to 2021. CONCLUSIONS: The COVID-19 pandemic led to declines in OM and MT case volumes that have started to increase. A geographic relationship may exist, and this connection could be influenced by mask mandates and social distancing.

The Effect of Adding Telemedicine to Comprehensive Care for Children with Medical Complexity: A Randomized Quality Improvement Trial

Research ObjectiveTelemedicine (TM) is widely used but has uncertain value. We assessed TM as method to further improve the outcomes and reduce costs of comprehensive care (CC) for children with medical complexity (CMC).Study DesignRandomized quality improvement trial comparing CC with TM and CC alone using Bayesian analyses with neutral prior (assuming no benefit) and stratifying by age (<2 years or ≥ 2 years) and estimated baseline risk (risk level 1 [positive‐pressure ventilation], risk level 2 [> expected median risk but no positive‐pressure ventilation], and risk level 3 [≤ expected median risk]). All study patients received CC that included primary care providers (PCPs) and specialists in the same clinic, 24/7 direct phone access to PCPs, low patient‐to‐PCP ratio (≤100:1), hospital consultation from PCPs during hospitalizations, and multiple other features to promote prompt effective care at all hours. The TM group also received audio‐visual communication (via Zoom for Healthcare) with the PCPs. The study outcomes were the Bayesian posterior probability of reducing days of care outside the home (in a clinic, ED, or hospital;primary outcome), the rate of children developing a serious illness (causing death, pediatric intensive care unit [PICU] admission, or hospital stay >7 days), and health system costs.Population StudiedHigh‐risk CMC (with a chronic disease and ≥ 2 hospitalizations or ≥ 1 PICU admission in the year before enrolling in our CC program) treated in the High‐Risk Children's Clinic at The University of Texas Health Science Center at Houston, Texas.Principal FindingsBetween August 22, 2018 and March 23, 2020, we randomized 422 CMC, 209 to CC with TM and 213 to CC alone before meeting the predefined stopping rule (≥75% probability of reduced care days outside the home). In intent‐to‐treat analyses, the probability of a reduction with CC with TM compared to CC alone was 99% for days of care outside the home (12.94 vs.16.94 per child‐year;Bayesian rate ratio [RR], 0.80 [95% Credible Interval, [0.66–0.98]), 95% for rate of children with a serious illness (0.29 vs. 0.62 per child‐year;RR, 0.68 [0.43, 1.07]), 90% for admissions (1.01 vs. 1.23 per child‐year;RR 0.83 [0.62–1.11), 97% for PICU admissions (0.38 vs. 0.67 per child‐year;RR 0.66 (0.42–1.03), and 91% for mean total health system costs ($33,718 vs. $41,281 per child‐year;Bayesian cost ratio, 0.85 [0.67–1.08]).ConclusionsThe addition of TM to CC for children with medical complexity likely reduced their total days of care outside the home, serious illnesses, other adverse outcomes, and health system costs.Implications for Policy or PracticeOur findings indicate that TM can be safely used with CC for low‐income, mostly Medicaid‐insured high‐risk CMC like ours to provide them with more convenient, readily accessible, and cost‐effective care while minimizing their exposure in medical settings. Reducing unnecessary exposures for CMC is especially important during the current COVID‐19 pandemic or any other outbreaks of contagious and seasonal illnesses.Trial RegistrationClinicalTrials.gov Identifier: NCT03590509.Primary Funding SourceTexas Medical Center Health Policy Institute Grant, UTHealth Learning Healthcare Scholars' Award,from grant 5KL2TR000370 from the Center for Clinical and Translational Sciences, grant 5 UL1TR00371 from the National Center for Advancing Translational Sciences.