Impact of unmet social needs on timing of tympanostomy tube placement

Abstract

Introduction

Unmet social needs (USN) focus on individual patient concerns; they are less dependent on geography than other social determinants of health (SDOH). Here we aim to characterize the impact of various USN on timing of tympanostomy tube (TT) placement.

Methods

A retrospective chart review of 815 patients 0–4 years old with first-time TT placement at our institution between January 1st, 2023, and July 1st, 2023, was conducted. The risk of each USN were recorded for patients according to the electronic medical record.

Results

Our study found that in the presence of any USN, the at-risk group (AR) had a 19 % longer time between surgery order and surgery than the not-at-risk group (NAR) (IRR1.19, 95 %CI 1.15–1.22,p < 0.01), which remained significant when adjusted for race and insurance (R/I) (IRR1.15, 95 %CI 1.11–1.18,p < 0.01), and race, insurance and clinical factors (R/I/C) (IRR1.10, 95 %CI 1.07–1.13,p < 0.01). When evaluating time from last reported ear infection to initial evaluation by otolaryngology, we found that for any USN, the AR group had a shorter time to presentation than the NAR, with the effect remaining significant in our adjusted models for R/I, and R/I/C (IRR0.97; 95 %CI 0.94–0.99,p = 0.02 and IRR0.81; 95 %CI 0.79–0.83,p < 0.01 and IRR0.70; 95 %CI 0.68–0.73,p < 0.01, respectively).

Conclusions

This study demonstrated that patients with any USN had a significantly longer time from surgery order to surgery than those NAR. The data suggests that USN and SDOH have a nuanced and interdependent relationship regarding delays in care. This study highlights specific USN that institutions can target to mitigate delays in care.