Factors influencing referral of patients with voice disorders from primary care to otolaryngology.
Factors influencing referral of patients with voice disorders from primary care to otolaryngology.
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DOI：
10.1002/lary.24280
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发表时间：
2014-01
期刊：
影响因子：
2.6
通讯作者：
Courey, Mark
中科院分区：
文献类型：
--
作者：
Cohen, Seth M.;Kim, Jaewhan;Roy, Nelson;Courey, Mark
评估在初级保健医生(PCP)进行初步评估后，喉部/嗓音疾病患者转诊至耳鼻咽喉科的频率、时机和影响因素。对一个大型的、全国性的美国行政索赔数据库进行了回顾分析。纳入了2004年1月1日至2008年12月31日期间根据ICD-9-CM编码患有喉部疾病的患者，被PCP诊断为门诊患者(有或没有耳鼻喉科受累)，并连续入选12个月。收集患者年龄、性别、地理区域、最后一次PCP喉部诊断、合并症情况、首次PCP就诊到首次耳鼻喉科就诊的时间、PCP门诊就诊次数和PCP喉部诊断数。进行COX和广义线性回归分析。149,653名独特的患者将PCP视为喉/嗓音疾病的门诊患者，其中136,152名(90.9%)仅看到PCP，6013名(4.0%)由PCP转诊至耳鼻咽喉科医生，3820名(2.6%)自我转诊至耳鼻咽喉科医生。急性喉炎与慢性喉炎、非特异性发音困难和喉癌相比，耳鼻咽喉科转诊的风险比(HR)更低。在耳鼻咽喉科转诊中，有多种并存情况的患者比没有并存情况的患者有更高的转诊比例。患者的年龄、性别和地理区域也影响耳鼻咽喉科的转诊。耳鼻咽喉科评估时间从1个月到3个月不等。PCP转诊患者进行耳鼻咽喉科评估的时间比自我转诊患者少。多种因素影响喉/嗓音疾病患者的耳鼻咽喉科转诊。需要对初级保健医生进行进一步的教育，使他们了解喉/嗓音疾病的适当耳鼻喉科转诊。
To evaluate the frequency, timing, and factors that influence referral of patients with laryngeal/voice disorders to otolaryngology following initial evaluation by a primary care physician (PCP). Retrospective analysis of a large, national administrative U.S. claims database. Patients with a laryngeal disorder based on ICD-9-CM codes from January 1, 2004 to December 31, 2008, seen by a PCP as an outpatient (with or without otolaryngology involvement), and continuously enrolled for 12 months were included. Patient age, gender, geographic region, last PCP laryngeal diagnosis, comorbid conditions, time from first PCP visit to first otolaryngology visit, number of PCP outpatient visits, and number of PCP laryngeal diagnoses were collected. Cox and generalized linear regressions were performed. 149,653 unique patients saw a PCP as an outpatient for a laryngeal/voice disorder with 136,152 (90.9%) only seeing a PCP, 6013 (4.0%) referred by PCP to an otolaryngologist, and 3820 (2.6%) self-referred to an otolaryngologist. Acute laryngitis had a lower hazard ratio (HR) for otolaryngology referral than chronic laryngitis, non-specific dysphonia, and laryngeal cancer. Multiple comorbid conditions had a greater HR for otolaryngology referral than having no comorbidities. Patient age, gender, and geographic region also affected otolaryngology referral. The time to otolaryngology evaluation ranged from < 1 month to > 3 months. PCP referred patients had less time to the otolaryngology evaluation than self-referred patients. Multiple factors affected otolaryngology referral for patients with laryngeal/voice disorders. Further education of PCPs regarding appropriate otolaryngology referral for laryngeal/voice disorders is needed.
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影响因子：
120.7
作者：
Grumbach, K;Selby, JV;Uratsu, C
通讯作者：
Uratsu, C
影响因子：
2.6
作者：
Byeon, Haewon;Lee, Yunhwan
通讯作者：
Lee, Yunhwan
DOI：
10.1044/1092-4388(2004/042
发表时间：
2004-06-01
影响因子：
2.6
作者：
Roy, N;Merrill, RM;Smith, EM
通讯作者：
Smith, EM
影响因子：
2.3
作者：
Talamini, R;Bosetti, C;Franceschi, S
通讯作者：
Franceschi, S
影响因子：
3.4
作者：
BENNINGER, MS;KING, F;NICHOLS, RD
通讯作者：
NICHOLS, RD