Can the Social Vulnerability Index Enhance Models Predicting Adherence to Craniofacial Speech Evaluations?

Abstract

ObjectiveTo determine whether the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) influences models of adherence to speech evaluations beyond individual demographic and clinical factors.DesignRetrospective cohort analysis.SettingTertiary children's hospital in the United States.ParticipantsFive hundred thirty-five children with cleft-related diagnoses scheduled for speech evaluations.Main Outcome MeasureAdherence to initial and follow-up speech evaluations.ResultsSVI was not predictive for adherence in logistic regression models. Children with private insurance had higher odds (OR) of attending initial evaluation (OR = 2.14, P < .001). Those with more severe cleft phenotypes were more likely to attend both initial (ORs 4.11-4.35, P < .001) and follow-up visits (ORs 6.29-7.49, P < .001). Children with velopharyngeal dysfunction and compensatory errors were also more likely to remain engaged in care.ConclusionSVI did not improve prediction of adherence. Insurance type, cleft phenotype, and speech function are the dominant factors influencing adherence to recommended speech evaluations.