Amarbir S Gill1, Daniel M Beswick2, Jess C Mace3, Dennis Menjivar1, Shaelene Ashby1, Ryan A Rimmer4, Vijay R Ramakrishnan5, Zachary M Soler6, Jeremiah A Alt1. 1. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City. 2. Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles. 3. Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland. 4. Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, Connecticut. 5. Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis. 6. Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.
Abstract
Importance: The distance traveled by patients for medical care is associated with patient outcomes (ie, distance bias) and is a limitation in outcomes research. However, to date, distance bias has not been examined in rhinologic studies. Objective: To evaluate the association of distance traveled by a cohort of patients with chronic rhinosinusitis with baseline disease severity and treatment outcomes. Design, Setting, and Participants: A total of 505 patients with chronic rhinosinusitis were prospectively enrolled in a multi-institutional, cross-sectional study in academic tertiary care centers between April 2011 and January 2020. Participants self-selected continued appropriate medical therapy or endoscopic sinus surgery. The 22-item Sinonasal Outcome Test (SNOT-22) and Medical Outcomes Study Short Form 6-D (SF-6D) health utility value scores were recorded at enrollment and follow-up. Data on the distances traveled by patients to the medical centers, based on residence zip codes, and medical comorbid conditions were collected. Exposures: Distance traveled by patient to obtain rhinologic care. Main Outcomes and Measures: SNOT-22 and SF-6D scores. Scores for SNOT-22 range from 0 to 110; and for SF-6D, from 0.0 to 1.0. Higher SNOT-22 total scores indicate worse overall symptom severity. Higher SF-6D scores indicate better overall health utility; 1.0 represents perfect health and 0.0 represents death. Results: The median age for the 505 participants was 56.0 years (IQR, 41.0-64.0 years), 261 were men (51.7%), 457 were White (90.5%), and 13 were Hispanic or Latino (2.6%). These categories were collected according to criteria described and required by the National Institutes of Health and therefore do not equal the entire cohort. Patients traveled a median distance of 31.6 miles (50.6 km) (IQR, 12.2-114.5 miles [19.5-183.2 km]). Baseline (r = 0.00; 95% CI, 0.00-0.18) and posttreatment (r = 0.01; 95% CI, -0.07 to 0.10) SNOT-22 scores, as well as baseline (r = -0.12; 95% CI, -0.21 to -0.04) and posttreatment (r = 0.07; 95% CI, -0.02 to 0.16) SF-6D scores, were not associated with distance. There was no clinically meaningful correlation between distance traveled and mean comorbidity burden. Nevertheless, patients with a history of endoscopic sinus surgery were more likely to travel longer distances to obtain care (Cliff delta = 0.28; 95% CI, 0.19-0.38). Conclusions and Relevance: Although this cross-sectional study found that some patients appear more willing to travel longer distances for chronic rhinosinusitis care, results suggest that distance traveled to academic tertiary care centers was not associated with disease severity, outcomes, or comorbidity burden. These findings argue for greater generalizability of study results across various cohorts independent of distance traveled to obtain rhinologic care. Trial Registration: ClinicalTrials.gov Identifier: NCT02720653.
Importance: The distance traveled by patients for medical care is associated with patient outcomes (ie, distance bias) and is a limitation in outcomes research. However, to date, distance bias has not been examined in rhinologic studies. Objective: To evaluate the association of distance traveled by a cohort of patients with chronic rhinosinusitis with baseline disease severity and treatment outcomes. Design, Setting, and Participants: A total of 505 patients with chronic rhinosinusitis were prospectively enrolled in a multi-institutional, cross-sectional study in academic tertiary care centers between April 2011 and January 2020. Participants self-selected continued appropriate medical therapy or endoscopic sinus surgery. The 22-item Sinonasal Outcome Test (SNOT-22) and Medical Outcomes Study Short Form 6-D (SF-6D) health utility value scores were recorded at enrollment and follow-up. Data on the distances traveled by patients to the medical centers, based on residence zip codes, and medical comorbid conditions were collected. Exposures: Distance traveled by patient to obtain rhinologic care. Main Outcomes and Measures: SNOT-22 and SF-6D scores. Scores for SNOT-22 range from 0 to 110; and for SF-6D, from 0.0 to 1.0. Higher SNOT-22 total scores indicate worse overall symptom severity. Higher SF-6D scores indicate better overall health utility; 1.0 represents perfect health and 0.0 represents death. Results: The median age for the 505 participants was 56.0 years (IQR, 41.0-64.0 years), 261 were men (51.7%), 457 were White (90.5%), and 13 were Hispanic or Latino (2.6%). These categories were collected according to criteria described and required by the National Institutes of Health and therefore do not equal the entire cohort. Patients traveled a median distance of 31.6 miles (50.6 km) (IQR, 12.2-114.5 miles [19.5-183.2 km]). Baseline (r = 0.00; 95% CI, 0.00-0.18) and posttreatment (r = 0.01; 95% CI, -0.07 to 0.10) SNOT-22 scores, as well as baseline (r = -0.12; 95% CI, -0.21 to -0.04) and posttreatment (r = 0.07; 95% CI, -0.02 to 0.16) SF-6D scores, were not associated with distance. There was no clinically meaningful correlation between distance traveled and mean comorbidity burden. Nevertheless, patients with a history of endoscopic sinus surgery were more likely to travel longer distances to obtain care (Cliff delta = 0.28; 95% CI, 0.19-0.38). Conclusions and Relevance: Although this cross-sectional study found that some patients appear more willing to travel longer distances for chronic rhinosinusitis care, results suggest that distance traveled to academic tertiary care centers was not associated with disease severity, outcomes, or comorbidity burden. These findings argue for greater generalizability of study results across various cohorts independent of distance traveled to obtain rhinologic care. Trial Registration: ClinicalTrials.gov Identifier: NCT02720653.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Irsa S Hasan; Hartzell V Schaff; Richard C Daly; Katherine S King; John M Stulak; Kevin L Greason; Joseph A Dearani Journal: Ann Thorac Surg Date: 2020-05-29 Impact factor: 4.330
Authors: Elias S Saba; John P Marinelli; Christine M Lohse; Michael J Link; Matthew L Carlson Journal: Otol Neurotol Date: 2020-02 Impact factor: 2.311
Authors: Richard R Orlandi; Todd T Kingdom; Timothy L Smith; Benjamin Bleier; Adam DeConde; Amber U Luong; David M Poetker; Zachary Soler; Kevin C Welch; Sarah K Wise; Nithin Adappa; Jeremiah A Alt; Wilma Terezinha Anselmo-Lima; Claus Bachert; Fuad M Baroody; Pete S Batra; Manuel Bernal-Sprekelsen; Daniel Beswick; Neil Bhattacharyya; Rakesh K Chandra; Eugene H Chang; Alexander Chiu; Naweed Chowdhury; Martin J Citardi; Noam A Cohen; David B Conley; John DelGaudio; Martin Desrosiers; Richard Douglas; Jean Anderson Eloy; Wytske J Fokkens; Stacey T Gray; David A Gudis; Daniel L Hamilos; Joseph K Han; Richard Harvey; Peter Hellings; Eric H Holbrook; Claire Hopkins; Peter Hwang; Amin R Javer; Rong-San Jiang; David Kennedy; Robert Kern; Tanya Laidlaw; Devyani Lal; Andrew Lane; Heung-Man Lee; Jivianne T Lee; Joshua M Levy; Sandra Y Lin; Valerie Lund; Kevin C McMains; Ralph Metson; Joaquim Mullol; Robert Naclerio; Gretchen Oakley; Nobuyoshi Otori; James N Palmer; Sanjay R Parikh; Desiderio Passali; Zara Patel; Anju Peters; Carl Philpott; Alkis J Psaltis; Vijay R Ramakrishnan; Murugappan Ramanathan; Hwan-Jung Roh; Luke Rudmik; Raymond Sacks; Rodney J Schlosser; Ahmad R Sedaghat; Brent A Senior; Raj Sindwani; Kristine Smith; Kornkiat Snidvongs; Michael Stewart; Jeffrey D Suh; Bruce K Tan; Justin H Turner; Cornelis M van Drunen; Richard Voegels; De Yun Wang; Bradford A Woodworth; Peter-John Wormald; Erin D Wright; Carol Yan; Luo Zhang; Bing Zhou Journal: Int Forum Allergy Rhinol Date: 2021-03 Impact factor: 5.426