Healthcare Resource Utilization for Chronic Rhinosinusitis in Older Adults.
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2021-06-25
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Abstract
Objectives
Chronic rhinosinusitis (CRS) is a common and costly health problem in the United States. While often associated with younger adults, CRS can affect the elderly. As the aging population increases in the United States, the cost burden of CRS in older adults is important to assess. The objective of this study is to characterize healthcare resource utilization (HCRU) and healthcare expenditure (HCE) for CRS in this population.Methods
Patients meeting criteria for CRS with three years of continuous data were identified on IBM® Marketscan Research Databases over a five-year period (2013-2017). Medication utilization, outpatient visits, surgery, and expenditures related to CRS were assessed for older adults (>65) and compared with other age groups. As a secondary analysis, multivariable generalized linear models were utilized to compare HCE while adjusting for baseline medication utilization.Results
A total of 238,825 patients met the inclusion criteria, of which 20,927 were older adults. Older adults had the highest overall prevalence of nasal polyps (10%) and asthma (16%) among adult groups. Surgery rate was lower than other adult groups, but medication utilization was the highest. Mean overall HCE at two years was highest in older adults (USD 2545 vs. 2298 in young adults). However, HCE was highest for the young adult group after adjusting for baseline medication usage.Conclusion
Older adults had a higher rate of CRS-related co-morbidities as well as the highest CRS-related medication utilization and unadjusted two-year HCE. Although the reasons for this are unclear, possibilities include greater disease severity and preference for medical versus surgical management. HCE for CRS is expected to increase as the aging population grows.Type
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Jang, David W, Hui-Jie Lee, Ryan J Huang, Jeffrey Cheng, Ralph Abi Hachem and Chuck D Scales (2021). Healthcare Resource Utilization for Chronic Rhinosinusitis in Older Adults. Healthcare (Basel, Switzerland), 9(7). pp. 796–796. 10.3390/healthcare9070796 Retrieved from https://hdl.handle.net/10161/23564.
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Scholars@Duke
David W Jang
My clinical expertise is in diseases of the nose, sinuses, and skull base. I perform endoscopic sinus surgery, nasal airway surgery, and minimally invasive endonasal surgery of the pituitary and skull base.
Jeffrey Cheng
My passion is for taking excellent care of children. After completing my residency training at Mount Sinai Medical Center in New York, I pursued a two-year pediatric otolaryngology fellowship at the Children's Hospital of Philadelphia (CHOP), where I received subspecialty training, which covered a wide breadth of otolaryngologic pathologies in children, as well as continued to grow and develop my expertise in comprehensive and coordinated care that is unique to the pediatric population. I have a particular clinical interest in pediatric airway disorders and chronic ear diseases, as well as anterior skull base surgery. I continue to be excited about the continued growth and development of our pediatric aerodigestive, hearing loss, and skull base surgery programs, in a multidisciplinary fashion.
Current Research InterestsMy research spans a wide range of pediatric otolaryngology conditions with over 50 peer reviewed publications. Currently, my focus is in patient quality and safety. As medical director for quality and safety for the Duke Children's Surgery Program and the Department of Head and Neck Surgery and Communication Sciences, I am really interested in building a culture of safety and advancing quality improvement science. I think that by working towards improving our processes and procedures we can reduce harms and waste and improve clinical outcomes for our patients.
Ralph Abi Hachem
Charles Douglas Scales
Charles D. Scales, Jr., MD MSHS FACS is Associate Dean for Clinical Research Initiatives and Associate Professor of Urology and Population Health Science. He completed medical school and residency training in urology at Duke University. After residency, Dr. Scales completed the Robert Wood Johnson Foundation Clinical Scholars Program at UCLA, where he received advanced training in health services research, health policy, and quality of care. He teaches these skills to future generations through the Duke Master of Management in Clinical Informatics (MMCi) degree program, and in 2025 will present his course, “Data, Information, and Health Care Transformation” for the 10th consecutive year.
From the research perspective, Dr. Scales has a longstanding interest in the epidemiology of and patient care for urinary stone disease. Recent studies have redefined the epidemiology of urinary stone disease in the United States, compared the effectiveness of dominant stone removal technologies, and identified new opportunities for improving patient-centered and policy-relevant outcomes, such as unplanned care after procedural interventions. His research and perspective on urinary stone disease has been highlighted in U.S. News & World Report, Reuters, NPR, and the Wall Street Journal, among other media outlets.
Currently, Dr. Scales leads a diverse health services and clinical research program at the Duke Clinical Research Institute, where he is the Principal Investigator for the Scientific Data and Research Center for the NIDDK Urinary Stone Disease Research Network (U01). Within the USDRN, he leads the multicenter Prevention of Urinary Stones with Hydration (PUSH) randomized clinical trial, which is the largest randomized controlled stone prevention trial to date, and the multicenter Study to Enhance Understanding of Stent-Associated Symptoms (STENTS) cohort study.
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