title: Practice variations in voice treatment selection following vocal fold mucosal resection.
abstract: To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population.
  
  
  
  Retrospective analysis of a large, nationally representative Medicare claims database.
  
  
  
  Patients with > 12 months of continuous Medicare coverage who underwent a leukoplakia- or cancer-related vocal fold mucosal resection (index) procedure during calendar years 2004 to 2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each postindex treatment type, treating the other treatment types as competing risks, and further evaluated postindex treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex, and Medicaid eligibility were used as predictors.
  
  
  
  A total of 2,041 patients underwent 2,427 index procedures during the study period. In 14% of cases, an initial voice treatment event was identified. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65 to 75 years, the likelihood of undergoing surgical treatment increased significantly with each 5-year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy.
  
  
  
  The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age, and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care.
  
  
  
  2c. Laryngoscope, 126:2505-2512, 2016.
authors.affiliation: Division of Otolaryngology, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Jaime E
authors.initials: JE
authors.lastname: Moore
authors.affiliation: Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Rathouz
authors.affiliation: Division of General Surgery, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Havlena
authors.affiliation: Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Division of Otolaryngology, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.|Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.|Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Seth H
authors.initials: SH
authors.lastname: Dailey
authors.affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.|Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
authors.affiliation: Division of General Surgery, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.|Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.|Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.affiliation: Division of Otolaryngology, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.. welham@surgery.wisc.edu.|Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.. welham@surgery.wisc.edu.|Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.. welham@surgery.wisc.edu.
authors.forename: Nathan V
authors.initials: NV
authors.lastname: Welham
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007820:Laryngeal Mucosa / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000601:surgery; D007828:Laryngoscopy / Q000009:adverse effects* / Q000379:methods; D007971:Leukoplakia / Q000601:surgery; D016013:Likelihood Functions; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States; D014827:Vocal Cords / Q000601:surgery; D014832:Voice Disorders / Q000209:etiology / Q000628:therapy*
keywords: Dysphonia; Medicare; practice patterns; speech therapy; thyroplasty; vocal fold injection; voice therapy