Geographic variation of endoscopic sinus surgery in the united states

Luke Rudmik, Chantal E. Holy, Timothy Smith

Research output: Contribution to journalArticle

23 Citations (Scopus)

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 χ2 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.

Original languageEnglish (US)
Pages (from-to)1772-1778
Number of pages7
JournalLaryngoscope
Volume125
Issue number8
DOIs
StatePublished - Aug 1 2015

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Observational Studies
Cohort Studies
Outcome Assessment (Health Care)
Databases
Health
Population

Keywords

  • appropriateness
  • chronic rhinosinusitis
  • Endoscopic sinus surgery
  • geographic variation
  • practice variation
  • quality of care
  • sinusitis

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Medicine(all)

Cite this

Geographic variation of endoscopic sinus surgery in the united states. / Rudmik, Luke; Holy, Chantal E.; Smith, Timothy.

In: Laryngoscope, Vol. 125, No. 8, 01.08.2015, p. 1772-1778.

Research output: Contribution to journalArticle

Rudmik, Luke ; Holy, Chantal E. ; Smith, Timothy. / Geographic variation of endoscopic sinus surgery in the united states. In: Laryngoscope. 2015 ; Vol. 125, No. 8. pp. 1772-1778.
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