The Triple Aim and its Implications on the Management of Chronic Rhinosinusitis

Barry, Jonnae Y.; McCrary, Hilary C.; Kent, Sean; Saleh, Ahlam; Chang, Eugene H.; Chiu, Alexander G.

doi:10.2500/ajra.2016.30.4348

Cited by 8 publications

(10 citation statements)

References 44 publications

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“…In other words, there may have been less improvement in health‐related QOL after ESS with increasing surgical wait time. This finding supports the observations from Hopkins et al., as delaying surgery in refractory CRS may lower prognosis due to alteration of the sinonasal architecture …”

Section: Discussionsupporting

confidence: 92%

“…To carry out this endeavor, 6 parameters are to be addressed: safety, effectiveness, patient centeredness, efficiency, equity, and timeliness . Within the context of medically recalcitrant chronic rhinosinusitis (CRS), there is evidence to suggest that timeliness of surgery represents an opportunity to improve care, because early surgical intervention may prevent the progression of CRS pathophysiology and the development of comorbid conditions, thereby reducing healthcare utilization . Benninger et al .…”

mentioning

confidence: 99%

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Wait times for endoscopic sinus surgery influence patient‐reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria

Yip

Hao

Eskander³

et al. 2018

Int Forum Allergy Rhinol

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Background: Previous studies on the impact of wait times for endoscopic sinus surgery (ESS) in medically recalcitrant chronic rhinosinusitis (rCRS) have not examined its influence on the 5 distinct symptoms domains of the 22-item Sino-Nasal Outcome Test (SNOT-22), and have not applied evidence-based surgical indications. Our primary study objective was to investigate the impact of ESS wait times on postoperative SNOT-22 global and symptom domain scores in patients with rCRS deemed "appropriate" surgical candidates. Methods:This was a retrospective analysis of adult patients with rCRS undergoing ESS, categorized as "appropriate" surgical candidates. Primary outcome measure was change in SNOT-22 global/symptom domain score (preoperative -6-month postoperative). Correlational analyses were performed between wait time and change in SNOT-22 global and symptom domain scores. For significant negative correlations, the threshold wait time to generate a worsening in health-related quality-of-life (HRQoL) equivalent to the mean clinically important difference (MCID) was calculated. Results: A total of 104 patients with a mean ± standard deviation (SD) wait time of 310.8 ± 155.9 days were analyzed. Postoperative SNOT-22 global and symptom domain scores significantly improved postoperatively. Wait time for ESS was negatively correlated with change in SNOT-22 global, rhinologic, extranasal rhinologic, and ear/facial domain scores (p < 0.05), and a wait time threshold of 287, 452, 421, and 381 days corresponded to a decrease equivalent to the MCID, respectively. Conclusion: We identified less improvement in HRQoL a er ESS with increasing surgical wait time. Moreover, prolonged wait times may result in less improvement in disease-specific symptoms, but do not appear to worsen psychological or sleep dysfunction. C 2018 ARS-AAOA, LLC. How to Cite this Article: Yip J, Hao W, Eskander A, Lee JM. Wait times for endoscopic sinus surgery influence patient-reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria. Int Forum Allergy Rhinol. 2019;9:396-401.

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Wait times for endoscopic sinus surgery influence patient‐reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria

Yip

Hao

Eskander³

et al. 2018

Int Forum Allergy Rhinol

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“…5 Furthermore, healthcare institutions are encouraged to work towards the triple aim put forth by the Institute for Healthcare Improvement for improved population health, improved patient experience of care, and lowered costs, which places further emphasis on the quality of care delivered. 6 …”

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confidence: 99%

The Affordable Care Act and Its Effects on Physician Leadership: A Qualitative Systematic Review

Sterbenz

Chung

2017

Quality Management in Health Care

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The Affordable Care Act (ACA) shifted the focus in medical care from quantity to quality. This qualitative systematic review determined the key skills to be an effective physician leader after the implementation of the ACA and to compare them to the key skills identified prior to its implementation. A qualitative systematic review collects qualitative data and can be analyzed in a number of ways, including thematic analysis that constructs themes from the pooled data. A systematic literature search on leadership skills for physicians resulted in 26 papers. Thematic analysis was used to categorize the data presented in each paper. The results from these 26 papers were then compared to a similar paper published prior to the implementation of the ACA. Teamwork and team-building, communication, and self-awareness skills were mentioned the most often. The percentage of papers mentioning teamwork and team-building skills (61.5%) was significantly greater than the percentage (25%) reported prior to the implementation of the ACA (p≤0.04). With the shift towards quality of patient care, healthcare workers at all levels should strive to work as a team to provide the best quality of care at all stages of patient care.

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“…With otolaryngology having been slow to transition to this new payment model, it is imperative that we stay engaged and take a proactive role in this process because it has great implications on our patients' outcomes and our own practices. Several articles in this issue of American Journal of Rhinology & Allergy contain themes relevant to this type of change.First is an intriguing article by Barry et al,1 who examined what the contemporary literature shows about early versus aggressive management of chronic rhinosinusitis (CRS) as it relates to patient experience, health outcomes, and overall cost burden. Their review demonstrated that early intervention with endoscopic sinus surgery in appropriately selected patients has the potential to improve outcomes and reduce the long-term cost burden of CRS.…”

mentioning

confidence: 99%

“…First is an intriguing article by Barry et al, 1 who examined what the contemporary literature shows about early versus aggressive management of chronic rhinosinusitis (CRS) as it relates to patient experience, health outcomes, and overall cost burden. Their review demonstrated that early intervention with endoscopic sinus surgery in appropriately selected patients has the potential to improve outcomes and reduce the long-term cost burden of CRS.…”

mentioning

confidence: 99%

Reality Bites: The Establishment of Accountable Care Organizations in Otolaryngology

Woodard¹

2016

Am J Rhinol�Allergy

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Although United States health care costs are significantly higher than any other industrialized country, we still lag behind many countries in health care equity and quality metrics. One feature of the Affordable Care Act that intended to address this was the establishment of Accountable Care Organizations (ACO). ACOs create a network of physicians that ostensibly will enhance care coordination among providers, improve patient experience and health outcomes, and lower overall costs. ACOs emphasize prevention and management of chronic diseases, and reward quality and cost-effective care, while attempting to move away from fee-for-service medicine. Unfortunately, although not always responsible for many of the metrics that determine cost or quality of care, physicians are largely held accountable for the delivery of high-quality and low-cost care. With otolaryngology having been slow to transition to this new payment model, it is imperative that we stay engaged and take a proactive role in this process because it has great implications on our patients' outcomes and our own practices. Several articles in this issue of American Journal of Rhinology & Allergy contain themes relevant to this type of change.First is an intriguing article by Barry et al.,1 who examined what the contemporary literature shows about early versus aggressive management of chronic rhinosinusitis (CRS) as it relates to patient experience, health outcomes, and overall cost burden. Their review demonstrated that early intervention with endoscopic sinus surgery in appropriately selected patients has the potential to improve outcomes and reduce the long-term cost burden of CRS.Besides early surgical intervention, medical management is another area that is likely to be affected by the ACO model. Aggressive medical management as a first-line therapy option may potentially improve clinical outcomes and reduce health care costs. Novel topical medicines in the treatment of CRS provide targeted therapy and reduce the adverse effects associated with systemic use of certain medications. Sodium hyaluronate has been described to promote wound and mucosal healing, but it has not been described in its use in CRS therapy. Cantone and Iengo 2 evaluated it use in combination with topical steroids and found improvement in symptoms, endoscopic examinations, and discomfort associated with CRS with nasal polyps (CRSwNP) compared with steroids alone.The impact that the quality metrics will have on physician reimbursements makes it imperative that otolaryngologists provide input into what specialty-specific performance measures are used. Dorresteijn et al. 3 reported on a newly developed severity metric, the Nasal Mucus Index. They studied the association of various inflammatory biomarkers and self-reported severity measures with the newly developed Nasal Mucus Index. The Nasal Mucus Index was found to correlate significantly with same-day interleukin-8 levels, polymorphonuclear neutrophils count, and Wisconsin Upper Respiratory Symptom Survey-21 scores. It is propose...

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The Triple Aim and its Implications on the Management of Chronic Rhinosinusitis

Cited by 8 publications

References 44 publications

Wait times for endoscopic sinus surgery influence patient‐reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria

Wait times for endoscopic sinus surgery influence patient‐reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria

The Affordable Care Act and Its Effects on Physician Leadership: A Qualitative Systematic Review

Reality Bites: The Establishment of Accountable Care Organizations in Otolaryngology

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