Barriers to Adoption of the Pre-Epiglottic Baton Plate (Tübingen Palatal Plate) for Infants With Robin Sequence

Abstract

Objective

Despite 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.

Design

An 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.

Participants

Of 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.

Results

Only 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%).

Conclusions

The 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.