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

Background: Comprehensive computerized gait analysis (CGA) alters orthopedic surgical plans and improves outcomes. Despite these documented benefits, CGA is not widely available to all patients who could be helped by it.

Research Question: Do social determinants of health impact access to CGA?

Methods: Retrospective review of patients seen for CGA from 2021 to 2022. Dates of referral, insurance approval and completion of CGA, demographics and insurance type were extracted from patient records. Zip codes were used to determine the neighborhood socioeconomic status (SES). Data were analyzed using non-parametric statistics.

Results: Insurance type affected time to authorization (private insurance/self-pay: median 9 days; HMO insurance: median 51.5 days; public insurance: median 27 days; p=0.0004). Once authorized, insurance type did not affect time to schedule and complete CGA (p=0.76). Lower neighborhood SES was associated with longer time to authorization but shorter time to complete CGA once authorized. Rescheduling was associated with longer time to complete CGA once authorized (median 29.5 vs. 16 days, p<0.0001). White, non-Hispanic families tended to reschedule more often than non-white or Hispanic families (35 % vs. 18 %, p=0.07).

Significance: Knowledge of barriers to CGA is necessary in order to design and implement effective strategies to widen its availability to all whom it could benefit. Social determinants of health and insurance type are associated with delays in authorization for CGA. Families with public insurance and HMO coverage experience delays in obtaining insurance authorization compared to PPO/self-pay patients, whose tests did not require prior authorization. However, there can also be delays in scheduling and completing CGA once authorized. This is a multi-faceted issue that requires further research.