O3253: Location and Insurance Status: Risk Factors for Hip Surveillance Non-Adherence in Pediatric Patients with Cerebral Palsy

Background: Radiographic hip surveillance allows for early identification of hip dysplasia in patients with cerebral palsy (CP) and has significantly decreased dislocation rates in certain settings. Adherence to surveillance protocols may be impacted by demographic, medical and socioeconomic factors. To better mitigate barriers to adherence, this study aims to identify whether specific medical and social factors affect adherence to hip surveillance guidelines in patients with CP.

Methods: A retrospective chart review of all pediatric patients with a clinical diagnosis of CP seen by the department of pediatric orthopaedic surgery at an urban, academic health system from June 2016-October 2023 was completed. All sub-types of CP were included. Adherence was determined by completed clinical encounters and radiographs as dictated by the Pediatric Orthopaedic Society of North America (POSNA) hip surveillance guidelines. Patient sex, insurance status, home address, need for interpreter, gross motor function classification system (GMFCS) level, migration percentage (MP) and medical comorbidities were abstracted from the medical record. Logistical regression was used to identify patient-specific risk factors for non-adherence to the recommended screening protocol. Covariates were analyzed using logistic regression to study interactions between variables.

Results: 130 patients were included; 57 (43.85%) identified as Hispanic, 85 (65.36%) were male, 34(26.15%) required the use of an interpreter, and 58 (44.62%) lived outside of Los Angeles County (LA) with 24 (41.37%) of those living outside of LA county living in Ventura County. In fully adjusted models, the odds ratio for adherence in patients who lived outside of LA was 3.992 times that of patients who lived in LA (log odds=1.3843, standard error (SE=0.53, p< 0.05). Controlling for the same variables, the odds ratio for adherence in patients with Covered California was 9.4103 times that of patients with HMO/PPO (log odds=2.2418, SE=1.01, p< 0.05).

Conclusion: Area of residence and insurance status appear to affect hip surveillance adherence rates. Of adherent patients, a high percentage resided in Ventura County (VC). Compared to LA residents, VC residents have both a higher median income compared to LA residents ($102,141 vs. $83,411) and a lower Area Deprivation Index (2-4 vs. 7-9). This may imply that higher SES patients are more adherent despite the barrier of increased travel-time to clinic. Interestingly, patients with private insurance (HMO/PPO) were significantly more likely to be non-adherent compared to those with publicly funded insurance. This trend could possibly be attributed to higher out of pocket payments with private insurance. Alternatively, patients with private insurance may “doctor shop” and visit multiple doctors for the same health concern to compare recommendations (and potentially miss vital information trends). Providers are encouraged to increase efforts to engage and support families with lower SES and educate parents on the importance of hip surveillance screening regardless of insurance status.