Luke Rudmik1, Chantal E Holy2, Timothy L Smith3. 1. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada. 2. Acclarent (c.e.h.), Menlo Park, California, U.S.A. 3. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: The objective of this study was to examine the rates and geographic variation of endoscopic sinus surgery (ESS) in a representative sample of the US working population. STUDY DESIGN: Observational cohort study using the MarketScan Commercial Claim and Encounters database. METHODS: All patients who received ESS between 2009 and 2013 were included. The annual adjusted rates of ESS per 1,000 people were calculated for each US state. Geographic variations were evaluated using the extremal quotient (EQ), weighted coefficient of variation (CV), systematic component of variance (SCV), and empirical Bayes statistic. The χ(2) statistic tests was used to quantify variation of the adjusted ESS rates across states within the US. RESULTS: The annual adjusted rate of ESS was 0.94 per 1,000 people in the US. South Dakota and Alabama were observed to have the highest rates of ESS, 1.80 and 1.69, respectively. Vermont and Arkansas were observed to have the lowest rates of ESS, 0.51 and 0.57, respectively. The mean EQ was 4.54, indicating a four- to fivefold difference between the highest (South Dakota) and lowest (Vermont) states. The mean CV was 31.4 and mean SCV was 10.1, which demonstrates very high variation. CONCLUSIONS: This study observed very high geographic variation in the rates of ESS across the United States. Given that practice variation indicates the presence of potentially harmful and inefficient unwarranted care, outcomes from this study indicate a need to further evaluate the delivery of ESS to improve overall health system performance. LEVEL OF EVIDENCE: 2b.
OBJECTIVES/HYPOTHESIS: The objective of this study was to examine the rates and geographic variation of endoscopic sinus surgery (ESS) in a representative sample of the US working population. STUDY DESIGN: Observational cohort study using the MarketScan Commercial Claim and Encounters database. METHODS: All patients who received ESS between 2009 and 2013 were included. The annual adjusted rates of ESS per 1,000 people were calculated for each US state. Geographic variations were evaluated using the extremal quotient (EQ), weighted coefficient of variation (CV), systematic component of variance (SCV), and empirical Bayes statistic. The χ(2) statistic tests was used to quantify variation of the adjusted ESS rates across states within the US. RESULTS: The annual adjusted rate of ESS was 0.94 per 1,000 people in the US. South Dakota and Alabama were observed to have the highest rates of ESS, 1.80 and 1.69, respectively. Vermont and Arkansas were observed to have the lowest rates of ESS, 0.51 and 0.57, respectively. The mean EQ was 4.54, indicating a four- to fivefold difference between the highest (South Dakota) and lowest (Vermont) states. The mean CV was 31.4 and mean SCV was 10.1, which demonstrates very high variation. CONCLUSIONS: This study observed very high geographic variation in the rates of ESS across the United States. Given that practice variation indicates the presence of potentially harmful and inefficient unwarranted care, outcomes from this study indicate a need to further evaluate the delivery of ESS to improve overall health system performance. LEVEL OF EVIDENCE: 2b.
Authors: Kristine A Smith; Richard R Orlandi; Gretchen Oakley; Huong Meeks; Karen Curtin; Jeremiah A Alt Journal: Int Forum Allergy Rhinol Date: 2018-12-20 Impact factor: 3.858
Authors: Sanna Toppila-Salmi; Heikki Rihkanen; Martti Arffman; Kristiina Manderbacka; Ilmo Keskimaki; Maija L Hytönen Journal: BMJ Open Date: 2018-10-18 Impact factor: 2.692