George A Scangas1,2, Stacey L Ishman3,4,5, Regan W Bergmark1,2, Michael J Cunningham2,6, Ahmad R Sedaghat1,2. 1. Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts. 2. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts. 3. Division of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 4. Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 5. Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, Cincinnati, Ohio. 6. Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts.
Abstract
OBJECTIVES/HYPOTHESIS: Uncomplicated acute rhinosinusitis (ARS) is most appropriately managed in an outpatient clinic setting. Some ARS patients present to emergency departments (EDs) for care. We investigates factors associated with ARS presentation to EDs versus outpatient settings. STUDY DESIGN: Cross-sectional study. METHODS: A total of 17,122,551 pediatric and adult patient visits from the 2009 and 2010 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys for ARS were identified. Patients with ARS complications were excluded. Univariate and multivariate associations identified demographic and socioeconomic characteristics of ARS patients independently associated with ED presentation. Temperature >100°F was used as a proxy for ARS severity. RESULTS: Patients with Medicaid (odds ratio [OR] = 10.82, P < .001) or no insurance (OR = 9.14, P < .001) more likely presented to EDs when compared to patients with private insurance or Medicare. Independently, black patients (OR = 6.01, P < .001) more likely presented to EDs when compared to white or Hispanic patients. No significant association was seen with metropolitan or socioeconomic status based upon the patients' home zip code. CONCLUSIONS: Presentation of ARS patients to EDs is associated with health insurance type and patient race independent of socioeconomic status. Healthcare access appears to be a primary determinant of whether patients present to an ED or outpatient setting for this common health problem. The association between race and ED presentation suggests cultural underpinnings requiring further characterization. Reducing barriers to care, for example through broader health insurance coverage, may enhance access to outpatient care providers and decrease costs associated with unnecessary ED presentation. LEVEL OF EVIDENCE: 4.
OBJECTIVES/HYPOTHESIS: Uncomplicated acute rhinosinusitis (ARS) is most appropriately managed in an outpatient clinic setting. Some ARSpatients present to emergency departments (EDs) for care. We investigates factors associated with ARS presentation to EDs versus outpatient settings. STUDY DESIGN: Cross-sectional study. METHODS: A total of 17,122,551 pediatric and adult patient visits from the 2009 and 2010 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys for ARS were identified. Patients with ARS complications were excluded. Univariate and multivariate associations identified demographic and socioeconomic characteristics of ARSpatients independently associated with ED presentation. Temperature >100°F was used as a proxy for ARS severity. RESULTS:Patients with Medicaid (odds ratio [OR] = 10.82, P < .001) or no insurance (OR = 9.14, P < .001) more likely presented to EDs when compared to patients with private insurance or Medicare. Independently, black patients (OR = 6.01, P < .001) more likely presented to EDs when compared to white or Hispanic patients. No significant association was seen with metropolitan or socioeconomic status based upon the patients' home zip code. CONCLUSIONS: Presentation of ARSpatients to EDs is associated with health insurance type and patient race independent of socioeconomic status. Healthcare access appears to be a primary determinant of whether patients present to an ED or outpatient setting for this common health problem. The association between race and ED presentation suggests cultural underpinnings requiring further characterization. Reducing barriers to care, for example through broader health insurance coverage, may enhance access to outpatient care providers and decrease costs associated with unnecessary ED presentation. LEVEL OF EVIDENCE: 4.
Authors: Sabina Dang; Justin R Shinn; Benjamin R Campbell; Gaelyn Garrett; Christopher Wootten; Alexander Gelbard Journal: Laryngoscope Date: 2019-07-29 Impact factor: 3.325
Authors: Kevin J Choi; Russel R Kahmke; Matthew G Crowson; Liana Puscas; Richard L Scher; Seth M Cohen Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-05-01 Impact factor: 6.223
Authors: Jeffrey Johnson; Zi Yang Jiang; Daniel Martinez; David Smith; Elizabeth Curtis; David Robinson; Ibrahim Alava Journal: Laryngoscope Investig Otolaryngol Date: 2017-11-30