Healthcare System Factors Affecting Preoperative Evaluation and Surgical Conversion in Adult Cochlear Implant Candidates.

Abstract

Investigate how healthcare system factors affect preoperative and surgical care of adult cochlear implant candidates. Retrospective cohort study. Tertiary academic care center. A medical record review of adult patients scheduled for cochlear implant evaluation from August 2018 to July 2023 was conducted. Independent variables included MyChart engagement, insurance type (Medicare, Medi-Cal, or private), and cochlear implant evaluation referral type (internal or external). Primary outcomes were time between referral and cochlear implant evaluation (appointment wait time), whether patients rescheduled missed appointments (appointment rescheduling), and whether patients underwent cochlear implantation (surgical conversion rate). Differences in appointment wait time, appointment rescheduling, and surgical conversion were assessed for patients with different insurance types, MyChart access, and referral types. A total of 121 patients were included in the analysis (62.8% men; 57.9% non-Hispanic; 44.6% aged 51-75). Patients with MyChart engagement (34%) were more likely to reschedule missed appointments (P < .001) and experience shorter appointment wait times (P = .015), with no difference in surgical conversion rate. Externally referred patients were significantly less likely to reschedule missed appointments compared to internally referred patients (P = .002) but did not have significantly different wait times or surgical conversion rates. Insurance type was not significantly associated with appointment wait times, rescheduling, or surgical conversion. Patient portal engagement and referral source both influence continuity and access for patients undergoing CI evaluation. Promoting portal adoption and streamlining referral workflows represent actionable targets for reducing barriers and improving access to cochlear implant care.