Delayed Indirect Referrals to the Pediatric Multidisciplinary Aerodigestive Program

Monday, October 13, 2025

2:54 PM - 3:00 PM EDT

Location: 233-234

Disclosure(s):

Eric Y. Du, MD MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kaitlyn R. Florence, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Rishi Kondapaneni, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Multidisciplinary aerodigestive programs (AeroD) have become integral in care for medically complex children; however, few patients are referred directly. Delayed indirect referrals for these patients have yet to be investigated.

Methods: A retrospective chart review of pediatric patients referred to AeroD at the University of Missouri Children’s Hospital since inception in 2016 was conducted. Sociodemographic characteristics, referral patterns, and medical history were collected. Direct referral was defined as initial referral to the AeroD program or nurse navigator, whereas indirect referral was those initially referred to an AeroD subspecialty prior to subsequent AeroD referral. In the latter, time to AeroD referral was recorded. Factors associated with direct referrals and earlier time to AeroD referral were analyzed with univariate cohort analysis and time to event Cox proportional hazards regression, respectively.

Results: Of 407 patients, 122 (30%) were directly referred at mean (SD) age of 10.9 (12.2) months, whereas the 285 (70%) initially referred to a subspecialist did so at a similar age of 10.3 (16.3) months (p = 0.69). The latter took an additional 5.4 (9.1) months for referral to AeroD. Direct referrals were more often from pediatricians (71.9% direct vs 56.1% indirect) and less from the neonatal intensive care unit (NICU) (5.8% vs 18.2%, p = 0.01). No difference was seen by practice type (academic: 66.7% vs 69.6%, p = 0.56). Dysphagia or aspiration were associated with more direct referrals (54.1% vs 30.5%, p = < 0.01; 6.6% vs 1.8%, p = 0.01) while bronchopulmonary dysplasia (BPD) fewer (0% vs 7%, p = < 0.01). In those indirectly referred, earlier AeroD presentation was associated with initial referral to speech language pathology (HR [95% CI] 1.75 [1.23, 2.47]) and negatively associated with older age (0.987 [0.974, 0.999] per month), NICU referral (0.57 [0.39, 0.88]), BPD (0.55 [0.36, 0.86]) or developmental delay (0.59 [0.37, 0.93]).

Conclusions: We identify risk factors for delayed indirect AeroD referrals. These have potential to be addressed to improve care in time-sensitive complex patients.

Presenting Author(s)

ED

Eric Y. Du, MD MPH

Resident Physician
University of Missouri Department of Otolaryngology-Head and Neck Surgery
Columbia, MO, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Kaitlyn R. Florence, MD

Resident Physician
University of Missouri-Columbia School of Medicine-Dept. Of Otolaryngology-Head and Neck Surgery
Columbia, MO, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Kaitlyn R. Florence, MD

Resident Physician
University of Missouri-Columbia School of Medicine-Dept. Of Otolaryngology-Head and Neck Surgery
Columbia, MO, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
AM

Aaron J. Meers, BS

University of Missouri School of Medicine, United States

Disclosure information not submitted.
MB

Michael Bodenhausen, BS

University of Missouri School of Medicine, United States

Disclosure information not submitted.
JT

Jacob Thoenen, BS

University of Missouri School of Medicine, United States

Disclosure information not submitted.
Rishi Kondapaneni, BS

Medical Student
University of Missouri School of Medicine
Dardenne Prairie, MO, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

EG

Eliav Gov-Ari, MD

Professor of Otolaryngology- head and neck surgery, and Child Health
University of Missouri - Department of Otolaryngology - Head and Neck Surgery
Columbia, MO, United States

Disclosure information not submitted.