2018 Section 5 - Rhinology and Allergic Disorders

CT practice pattern survey

changes in mucosal thickening and retained secretions rel- ative to the air-bone interface. 3 CT imaging helps delineate paranasal sinus anatomy, defines the extent and nature of underlying inflammatory disease, and provides a roadmap for functional endoscopic sinus surgery (FESS). A recent analysis of the National Ambulatory Medical Care Survey from 2005 through 2008 showed that oto- laryngologists use advanced radiographic imaging at a sta- tistically significant higher rate than primary care physi- cians per outpatient visit for diagnosis of CRS (16.0% vs 1.93%). 4 This widespread utility underscores the concerns related to sinus CT imaging, including potential for overuti- lization, substantial costs, and excessive radiation expo- sure. A recent clinical consensus statement by the Ameri- can Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) convened an expert panel be convened to cod- ify appropriate usage of CT for paranasal sinus disease. 5 Further, the American College of Radiology (ACR) recently published appropriateness criteria to guide imaging deci- sions for paranasal sinus disease. 2 Despite these guidelines, the exact usage patterns for CT imaging in adult CRS for practicing otolaryngologists re- main largely unknown. With this in mind, the current sur- vey, supported by the AAO-HNS and American Rhinologic Society (ARS), was conducted to better ascertain clinical practice patterns of CT imaging and financial implications of point-of-care (POC) imaging in the management of CRS. The impact of key variables, eg, years and type of practice and owning a scanner, was ascertained on CT utilization patterns. Materials and methods A 29-item survey was created and vetted by the Pa- tient Advocacy Committee of the ARS and the Imag- ing Committee of the AAO-HNS. It was subsequently reviewed by the AAO-HNS Research, Quality, and Health Policy Department and approved by the ARS and AAO-HNS Board of Directors. The electronic survey (http://www.surveymonkey.com/s/ctimaging) was dissem- inated to the AAO-HNS and ARS membership through multiple mechanisms: electronic messenger service (twice each by AAO-HNS and ARS), ENT Advocate (once), and AAO-HNS Bulletin (once). The target group included 8000 practicing U.S. otolaryngologists. Percentages for each re- sponse were calculated based on number of responses for each question (range, 73 to 331 responses). Due to round- ing, not all percentages added to 100%. The study did not involve direct patient contact or access to their health infor- mation; therefore, it was exempt from Institutional Review Board (IRB) approval. Particular areas explored included number of years in practice, type of practice, and geographic location of the clinical practice. The percentage of practice devoted to rhi- nology and number of patients presenting with nasal and sinus complaints per week were determined. Specific prac- tice patterns for the role of CT imaging of the paranasal

sinuses in the diagnosis of adult CRS was assessed. The role of CT imaging in FESS was also ascertained. The location of CT scan acquisition and socioeconomic as- pects of POC imaging in the office setting were evalu- ated. The radiation dosage of the CT scanning was also queried. Geographic regions for the survey were defined as follows: New England (Maine, Vermont, New Hampshire, Massachusetts, Connecticut, Rhode Island); Mid-Atlantic (New York, New Jersey, Pennsylvania); Mountain (Wyoming, Idaho, Montana, Nevada, Utah, Colorado, New Mexico, Arizona); North Central (North Dakota, South Dakota, Nebraska, Kansas, Missouri, Iowa, Min- nesota, Wisconsin, Illinois, Michigan, Indiana, Ohio); South Central (Texas, Oklahoma, Arkansas, Kentucky, Tennessee, Mississippi, Alabama, Louisiana); Southeast (Washington, DC, Maryland, Delaware, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida); and West (Washington, Oregon, California, Alaska, Hawaii). Statistical methodology The chi-squared test was performed to determine the asso- ciation between key variables, including years in practice ( > 10 years), academic vs private practice, geographic loca- tion, percentage of practice devoted to rhinology ( > 50%), and presence of in-office CT scanner with usage of CT scans in clinical practice (whether the scan was per- formed for confirmation prior to initiating therapy, af- ter 1 round of medical therapy, and to rule out sinusi- tis in patients with headaches). For those associations that were statistically significant, the odds ratio was computed to assess the direction of the dependence. Calculations were performed using IBM SPSS version 20 (IBM, Ar- monk, NY). A p value < 0.05 was considered statistically significant. A total of 331 respondents completed the electronic survey. The survey was disseminated to both ARS and AAO-HNS membership; the exact response rate could not be calcu- lated because there is overlap of membership in these or- ganizations. The years in clinical practice was as follows: < 5 years (74; 22.4%), 5 to 10 years (61; 18.4%), 10 to 20 years (85; 25.7%), 20 to 30 years (68; 20.5%), and > 30 years (43; 13.0%). The type of clinical practice was most commonly academic in 129 (39.1%), single specialty ( > 3 physicians) in 74 (22.4%), single specialty (1 to 3 physi- cians) in 52 (15.8%), multispecialty in 45 (13.6%), and solo in 30 (9.1%). Figure 1 shows the geographic location of the 320 responding physicians. Results Respondent demographics

International Forum of Allergy & Rhinology, Vol. 5, No. 6, June 2015

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