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How Variable are Patient Comorbidity Profiles Among Practicing Otolaryngologists?
Sina J Torabi1, Ellen M Hong1, Rahul A Patel2
1Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA.
Insights
Otolaryngologists (ORLs) in urban, academic settings, and early in their careers treat patients with more comorbidities. This variability in patient complexity may impact practice costs and outcomes, potentially leading to health inequities.
Area of Science:
- Otolaryngology
- Health Services Research
- Health Equity
Background:
- Physician practice patterns can influence patient outcomes and healthcare costs.
- Understanding comorbidity distribution among otolaryngologists (ORLs) is crucial for resource allocation and equitable care.
- The Hierarchical Condition Category (HCC) risk score serves as a validated measure of patient comorbidity burden.
Purpose of the Study:
- To investigate variations in patient comorbidity profiles among otolaryngologists (ORLs).
- To identify physician characteristics associated with treating patients with higher comorbidity burdens.
- To explore potential implications for health equity in otolaryngology practice.
Main Methods:
- A cross-sectional, population-based analysis using the 2019 Medicare Provider Utilization and Payment Dataset.
- Calculated average HCC risk scores for Medicare patients treated by each ORL.
- Stratified and compared HCC scores based on physician characteristics: practice region, rurality, years in practice, gender, subspecialty, and practice setting (academic vs. community).
Main Results:
- The mean HCC risk score among 8959 ORLs was 1.35 ± 0.35.
- ORLs in urban settings, academic practices, and early in their careers had significantly higher patient HCC risk scores (P < .001).
- Multivariate analysis confirmed that rural practice setting (OR: 0.58) and community setting (OR: 0.36) were associated with lower odds of high-risk patients, while recent graduation (2000-2015) was linked to increased odds.
Conclusions:
- Significant variability exists in patient comorbidity profiles among otolaryngologists.
- Physicians in urban, academic settings, and those more recently graduated manage patients with higher comorbidity burdens.
- These practice variations have potential implications for healthcare costs, clinical outcomes, and health equity within otolaryngology.
Objective:
To determine whether certain groups of otolaryngologists (ORLs) are treating cohorts of patients with more comorbidities.
Study Design:
Cross-sectional population-based analysis.
Setting:
2019 Medicare Provider Utilization and Payment Dataset.
Methods:
Each ORL's average Medicare hierarchical condition category (HCC) risk score, a comorbidity index calculated from a patient's comorbidities, was collected. These were stratified and compared by various physician characteristics, including practice region and rurality, years in practice, gender, subspecialty, and setting (academic vs community).
Results:
Among 8959 ORLs, the mean HCC risk score for Medicare patients was 1.35 ± 0.35. On univariate analysis, ORLs practicing in urban (compared to rural), ORLs in academic settings (compared to community), and early career ORLs all had a patient population with a higher HCC risk score (P < .001 for all). On multivariate analysis controlling for gender, rurality, graduation year, and region, rural setting was associated with decreased odds of having a high-risk patient population (odds ratio: 0.58 [95% confidence interval, CI: 0.48-0.71]; P < .001), while those more recently graduated has an increased risk (2000-2009: 1.41 [1.01-1.96], P = .046; 2010-2015: 2.30 [1.63-3.25], P < .001). In a separate subgroup analysis, subspecialty differences were seen and community setting was associated with decreased odds of having a high-risk patient population (0.36 [0.23-0.55]; P < .001).
Conclusion:
There is variability in patient comorbidity profiles among ORLs, with those in urban settings, those more recently graduated, and those in academic settings treating a group with more comorbidities. As the comorbidity burden may increase the cost of practice and complications, these findings may have important implications for health inequity.
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