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Impact Of Insurance Status On Treatment Outcomes And Compliance In Orthotic Helmet Therapy For Plagiocephaly
Adam H. Junn, BS, Sacha Hauc, BS, BA, MPH, Aaron S. Long, BS, Jean Carlo Rivera, BS, Hemali P. Shah, BS, Alexandra Junn, AB, Jacob Dinis, BS, John A. Persing, MD, Michael Alperovich, MD, MSc.
Yale Medicine, New Haven, CT, USA.

Impact of Insurance Status on Treatment Outcomes and Compliance in Orthotic Helmet Therapy for Plagiocephaly
Purpose: Deformational Plagiocephaly (DP) is a condition in which an infantís skull is misshapen due to uneven external pressure. This study investigates the impact of insurance status on patient compliance and outcomes after orthotic helmet therapy for DP correction.
Methods: Demographic variables were collected on patients who presented to Cranial Technologies for orthotic helmeting from 2014 to 2020 across 21 states. Forward stepwise multivariate regression was conducted to identify the relationship between insurance status and poor outcomes of patients treated with orthotic helmeting for DP.
Results: There were a total of 211,417 patients, of whom 141,513 received treatment at a Cranial Technologies facility. Patients with Medicaid and Tricare were more likely to exit treatment with ultrabrachycephaly when compared to patients with private insurance (OR: 1.578, CI: 1.506-1.654, p < 0.0001; OR: 1.658, CI: 1.324-2.076, p < 0.0001). Compared to patients with private insurance, patients with Medicaid and Tricare were less likely to show treatment compliance (OR: 0.398, CI: 0.380-0.418, p < 0.0001; OR: 0.774, CI: 0.599-1.001, p = 0.0506, respectively). Patients with Medicaid were more likely to rate their outcomes as poor on a self-reported survey (OR: 3.254, p < 0.0001).
Conclusions: Our study investigating socioeconomic factors in helmet therapy across 21 states found that patients with Medicaid had worse craniometric and patient-rated outcomes compared to those with commercial insurance. Additionally, we found that insurance through Medicaid was associated with lower levels of compliance with therapy. This may explain the disparities in outcomes and provide an opportunity for strategies to promote effective helmet treatment among patients at greater risk of treatment failure.


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