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Practice variations in voice treatment selection following vocal fold mucosal resection
Author(s) -
Moore Jaime E.,
Rathouz Paul J.,
Havlena Jeffrey A.,
Zhao Qianqian,
Dailey Seth H.,
Smith Maureen A.,
Greenberg Caprice C.,
Welham Nathan V.
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25911
Subject(s) - medicine , socioeconomic status , medicaid , population , retrospective cohort study , incidence (geometry) , surgery , health care , physics , environmental health , optics , economics , economic growth
Objectives/Hypothesis To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population. Study Design Retrospective analysis of a large, nationally representative Medicare claims database. Methods Patients with > 12 months of continuous Medicare coverage who underwent a leukoplakia‐ or cancer‐related vocal fold mucosal resection (index) procedure during calendar years 2004 to 2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each postindex treatment type, treating the other treatment types as competing risks, and further evaluated postindex treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex, and Medicaid eligibility were used as predictors. Results A total of 2,041 patients underwent 2,427 index procedures during the study period. In 14% of cases, an initial voice treatment event was identified. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65 to 75 years, the likelihood of undergoing surgical treatment increased significantly with each 5‐year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy. Conclusion The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age, and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care. Level of Evidence 2c. Laryngoscope , 126:2505–2512, 2016