Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, U.S.A.
Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, U.S.A.
Laryngoscope. 2021 Dec;131(12):2641-2648. doi: 10.1002/lary.29588. Epub 2021 Apr 27.
OBJECTIVES/HYPOTHESIS: Chronic rhinosinusitis (CRS) is a common and costly health problem in the United States. A better understanding of healthcare resource utilization (HCRU) and healthcare expenditure (HCE) pertaining to CRS is required. The objective of this study is to investigate geographic variations in HCRU and HCE for CRS.
STUDY TYPE/DESIGN: Retrospective study of administrative database.
Patients meeting pre-defined diagnostic criteria for CRS with continuous 1-year pre-index and 2-year post-index data were identified on IBM® Marketscan Research Databases over a 5-year period (2013-2017). Data pertaining to demographics, HCRU, and HCE were analyzed according to geographic region. Multivariable generalized linear models accounted for age, sex, baseline medication utilization, and co-morbidities.
About 237,969 patients were included. Antibiotics were the most commonly prescribed medication (95%). Surgery rate (11%), immunotherapy (9.2%), oral steroid use (66%), and antibiotic utilization (mean 6.3 prescriptions) were highest in the South. However, visits with an otolaryngologist were considerably higher in the Northeast (62%). The Northeast region had the highest mean HCE ($2,449), which was 13% greater than HCE for the North Central region ($2,172). HCRU and HCE were higher in urban areas across all metrics, with 2-year HCE being 18% greater in urban areas ($2,374 vs. $2,019). Significant geographic variation in HCE was observed even after adjusting for covariates.
Significant geographic variations in HCRU and HCE exist for CRS even after adjusting for covariates. Future studies are needed to help direct quality improvement and cost-saving efforts as well as efficient resource allocation in an era of value-based care.
4 Laryngoscope, 131:2641-2648, 2021.
目的/假设：慢性鼻-鼻窦炎（CRS）是美国一种常见且代价高昂的健康问题。需要更好地了解与 CRS 相关的医疗资源利用（HCRU）和医疗支出（HCE）。本研究的目的是调查 CRS 的 HCRU 和 HCE 的地域差异。
研究类型/设计：基于行政数据库的回顾性研究。
在 IBM® Marketscan 研究数据库中，通过 5 年（2013-2017 年）的时间，对符合 CRS 预先定义诊断标准且具有 1 年索引前和 2 年索引后连续数据的患者进行了识别。根据地理位置分析了与人口统计学、HCRU 和 HCE 相关的数据。多变量广义线性模型考虑了年龄、性别、基线药物利用和合并症。
共纳入约 237969 例患者。抗生素是最常用的药物（95%）。南部地区手术率（11%）、免疫疗法（9.2%）、口服类固醇使用（66%）和抗生素利用（平均 6.3 个处方）最高。然而，东北地区耳鼻喉科就诊量明显较高（62%）。东北地区的平均 HCE（$2449）最高，比中北部地区的 HCE 高 13%（$2172）。在所有指标中，城市地区的 HCRU 和 HCE 均较高，城市地区的 2 年 HCE 比农村地区高 18%（$2374 比$2019）。即使在调整了协变量后，仍观察到 HCE 存在显著的地域差异。
即使在调整了协变量后，CRS 的 HCRU 和 HCE 仍存在显著的地域差异。在价值为基础的医疗时代，需要进一步研究以帮助指导质量改进和节省成本的努力以及资源的有效分配。
4 Laryngoscope，131：2641-2648，2021。
