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Published on: November 17, 2016
Barriers to Adoption of the Pre-Epiglottic Baton Plate (Tübingen Palatal Plate) for Infants With Robin Sequence
David C Thean1, Snigdha Jindal1, Cory M Resnick1,2
1Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
Insights
The pre-epiglottic baton plate (PEBP) for infant airway obstruction shows slow adoption in North America due to perceived lack of evidence and fabrication support. Addressing these barriers can improve treatment accessibility for infants with Robin sequence.
Area of Science:
- Craniofacial Surgery
- Pediatric Otolaryngology
- Medical Device Implementation
Background:
- Upper airway obstruction (UAO) management in infants with Robin sequence (RS) is critical.
- The pre-epiglottic baton plate (PEBP) is an effective treatment option for UAO in RS.
- Adoption of PEBP in North America has been notably slow despite evidence.
Purpose of the Study:
- To identify barriers hindering PEBP implementation in North America.
- To explore opportunities for overcoming these identified barriers.
- To understand provider perspectives on PEBP for RS management.
Main Methods:
- A survey was distributed to craniofacial unit providers managing RS.
- Data were collected from a compiled email listserv of relevant specialists.
- Descriptive statistics were calculated for 122 valid responses.
Main Results:
- Only 9% of respondents currently offer PEBP treatment.
- Key barriers include doubts about clinical effectiveness (54.9%) and staff availability for fabrication (33.6%).
- Other barriers include family acceptance concerns (27.9%) and billing/insurance clarity (15.6%).
Conclusions:
- Perceived insufficiency of evidence and lack of trained staff are primary barriers to PEBP adoption.
- Augmenting the body of literature and providing fabrication training are key opportunities.
- Addressing these issues can facilitate wider implementation of PEBP for RS.
Abstract:
ObjectiveDespite evidence of effective management of upper airway obstruction (UAO) in infants with Robin sequence (RS), adoption of the pre-epiglottic baton plate (PEBP) has been slow in North America. The objectives of this study were to identify barriers and elucidate opportunities to overcome them.DesignAn email list of providers in craniofacial units involved in management of RS was compiled using published data form the American Cleft Palate-Craniofacial Association and institutional websites. A custom-designed survey was distributed to the compiled listserv. Responses were aggregated and descriptive statistics were calculated.ParticipantsOf 2142 distributed, 139 responses were received (yield 6.5%). Seventeen were excluded, resulting in 122 responses from 80 (65.6%) surgeons and 42 (34.4%) nonsurgeons.ResultsOnly 11 (9.0%) respondents reported that they currently offer PEBP treatment, and only 33 (27.5%) feel there is sufficient clinical evidence to support the use of PEBP. The most commonly reported barriers to implementation were doubts about clinical effectiveness (n = 67, 54.9%), availability of staff to fabricate the appliance (n = 41, 33.6%), concerns about family acceptance (n = 34, 27.9%), the potential for the appliance to cause harm (n = 26, 21.3%), and lack of clarity in billing and insurance coverage (n = 19, 15.6%).ConclusionsThe primary barriers to adoption of the PEBP in North America are a perceived insufficiency of evidence of its effectiveness and lack of appropriate staff to fabricate the appliances. Identification of these concerns provides opportunities to augment the body of literature and to identify and educate providers on fabrication techniques.
