Comprehensive computerized gait analysis: Barriers to access for children and adolescents

Area of Science:

• Orthopedics
• Health Services Research
• Socioeconomic Determinants of Health

Background:

• Comprehensive computerized gait analysis (CGA) is crucial for orthopedic surgical planning and improving patient outcomes.
• Despite proven benefits, access to CGA remains limited for many eligible patients.
• Barriers to CGA access require investigation to ensure equitable healthcare delivery.

Purpose of the Study:

• To investigate the impact of social determinants of health on access to comprehensive computerized gait analysis (CGA).
• To identify specific factors, including insurance type and socioeconomic status, that influence CGA accessibility.

Main Methods:

• Retrospective review of patient records for CGA referrals between 2021 and 2022.
• Extraction of referral dates, insurance authorization timelines, and completion of CGA.
• Utilized zip codes to determine neighborhood socioeconomic status (SES) and analyzed data using non-parametric statistics.

Main Results:

• Insurance type significantly affected authorization timelines: HMO (median 51.5 days) and public insurance (median 27 days) were longer than private/self-pay (median 9 days).
• Lower neighborhood SES correlated with longer authorization times but shorter completion times post-authorization.
• Rescheduling was associated with extended completion times (median 29.5 vs. 16 days), with White, non-Hispanic families rescheduling more frequently.

Conclusions:

• Social determinants of health and insurance type are significant contributors to delays in obtaining authorization for CGA.
• Patients with public or HMO insurance face authorization hurdles compared to PPO/self-pay patients.
• Addressing these multifaceted barriers is essential to broaden access to CGA for all patients who can benefit.