Just Do It—Everyone Should Follow the Guidelines

xlomafota13 shared this article with you from Inoreader Just Do It—Everyone Should Follow the Guidelines Via JAMA Otolaryngology–Head & Neck Surgery Current Issue Hearing loss is the most common congenital sensory impairment, and by age 19 years, 15.2% of participants in the 2009 to 2010 National Health and Nutrition Examination Survey had a measurable degree of hearing loss. In this issue of JAMA Otolaryngology–Head & Neck Surgery, Qian et al investigated factors associated with variability in following 2016 International Pediatric Otolaryngology Group (IPOG) consensus guidelines for diagnostic evaluation in pediatric patients with sensorineural hearing loss (SNHL). They used data for 53 711 unique patients from the Optum Clinformatics Data Mart, a nationally representative database containing claims from a large national private insurer with an annual sample size of 12 million unique patients. They recorded patient visits in hospitals, emergency departments, and outpatient practices in p ediatrics, otolaryngology, and audiology from January 1, 2008, to December 31, 2018. Assessed variables included the degree and type of hearing loss and diagnostic tests ordered, including electrocardiogram, cytomegalovirus (CMV) testing, magnetic resonance imaging (MRI), computed tomography (CT), and genetic testing, and interventions including cochlear implant (CI) surgery, hearing aid (HA)–related services, and speech language pathology (SLP) therapy. They collected demographic characteristics, socioeconomic status, clinician type, and cost data. The results of the study by Qian et al showed that national practice patterns were not consistent with the IPOG guidelines, with only 30% of children with SNHL having some form of diagnostic testing. Undergoing diagnostic testing was associated with increased use of interventions, including HA services, CI, and SLP services. Even after accounting for diagnostic testing, racial/ethnic and economic disparities persisted in SLP and HA ser vices, although not for CI. Although generally genetic testing and MRI use increased and CT use declined, CMV and genetic testing remained underused. After controlling for demographic and clinical factors, racial/ethnic and economic disparities were seen for CT, electrocardiogram, MRI, and genetic testing. Importantly, the type of clinician that the patient saw was associated with the odds of receiving certain diagnostic tests and interventions, with pediatric otolaryngologists and geneticists more likely to order all diagnostic modalities and recommend SLP services compared with general otolaryngologists, neurotologists and nonotolaryngologists. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.