Patient Use of Low-cost Digital Videoscopes and Smartphones for Remote Ear and Oropharyngeal Examinations.

Importance: During the novel coronavirus disease 2019 pandemic, telehealth has become a vital component of health care delivery. For otolaryngology evaluations, examination of the ear and oropharynx is important but difficult to achieve remotely. Objective: To assess the feasibility of patient use of low-cost digital videoscopes and smartphones for examination of the ear and oropharynx. Design, Setting, and Participants: A prospective quality improvement study was conducted in an academic adult otolaryngology clinic including 23 patients who presented for an in-person appointment and owned a smartphone device. The study was conducted from July 1 to 15, 2020. Interventions: Participants were asked to capture pictures and videos of their ear canals and oropharynx with digital videoscopes and their smartphones under real-time guidance over a telehealth platform. They were then surveyed about their experience. Main Outcomes and Measures: The primary outcomes were ratings by health care clinicians and a blinded otolaryngologist reviewer of image acceptability. Secondary outcomes included participant time to image acquisition and willingness to purchase digital videoscopes for telehealth use. Results: Of the 23 participants included, 14 were women (61%); mean age was 50 years (range, 21 to 80 years). Of the images obtained using the digital otoscope ear examination, 95% were considered acceptable by the health care clinicians and 91% were considered acceptable by the blinded reviewer; 16 participants (70%) reported that the otoscope was easy to use. The mean time to acquire images for both ears was 114 seconds (95% CI, 84-145 seconds). Twenty-one participants (91%) were willing to pay for a digital otoscope for telehealth use. For the oropharyngeal examination, a greater proportion of smartphone video examinations were considered acceptable by clinicians (63% acceptability) and the blinded reviewer (55%) compared with the digital endoscope (clinicians, 40%; blinded reviewer, 14%). The mean time required for the oropharyngeal examination smartphone video capture was shorter at 35 seconds compared with both the digital endoscope (difference, -27 seconds; 95% CI, -7 to -47 seconds) and smartphone photo capture (difference, -53 seconds; 95% CI, -20 to -87 seconds). Conclusions and Relevance: Digital otoscopes and smartphones apparently can facilitate remote head and neck physical examination in telehealth. Digital otoscopes were useful for ear examinations, and smartphone videos appeared to be the most useful for oropharyngeal examinations. Further studies are required to determine specific diagnostic capabilities in various telehealth practice settings.

Association Between Surgeon Scorecard Use and Operating Room Costs.

Importance: Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. Objective: To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. Design, Setting, and Participants: The OR Surgical Cost Reduction (OR SCORE) project was a single-health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology-head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186). Interventions: From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon's baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal. Main Outcomes and Measures: The primary outcome was each group's median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index-adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey. Results: The median surgical supply direct costs per case decreased 6.54% in the intervention group, from $1398 (interquartile range [IQR], $316-$5181) (10 637 cases) in 2014 to $1307 (IQR, $319-$5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from $712 (IQR, $202-$1602) (16 441 cases) in 2014 to $765 (IQR, $233-$1719) (17 227 cases) in 2015. This decrease represents a total savings of $836 147 in the intervention group during the 1-year study. After controlling for surgeon, department, patient demographics, and clinical indicators in a mixed-effects model, there was a 9.95% (95% CI, 3.55%-15.93%; P = .003) surgical supply cost decrease in the intervention group over 1 year. Patient outcomes were equivalent or improved after the intervention, and surgeons who received scorecards reported higher levels of cost awareness on the health care value survey compared with controls. Conclusions and Relevance: Cost feedback to surgeons, combined with a small departmental financial incentive, was associated with significantly reduced surgical supply costs, without negatively affecting patient outcomes.

Obstructive sleep apnea surgery practice patterns in the United States: 2000 to 2006.

OBJECTIVE: To determine obstructive sleep apnea (OSA) surgical volume, types, costs, and trends. To explore whether specific patient and hospital characteristics are associated with the performance of isolated palate versus hypopharyngeal surgery and with costs. STUDY DESIGN: Cross-sectional study. SETTING: Inpatient and outpatient medical facilities in the United States. SUBJECTS AND METHODS: OSA procedures were identified in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for 2000, 2004, and 2006 and from State Ambulatory Surgery Databases and State Inpatient Databases for 2006 from four representative states (California, New York, North Carolina, and Wisconsin). National combined inpatient and outpatient surgery estimates for 2006 were generated using a combination of databases. Chi-square and regression analysis examined procedure volume and type and inpatient procedure costs. RESULTS: In 2006, an estimated 35,263 surgeries were performed in inpatient and outpatient settings, including 33,087 palate, 6561 hypopharyngeal, and 1378 maxillomandibular advancement procedures. The odds of undergoing isolated palate surgery were higher for younger (18-39 yrs) and black patients. Outpatient procedures were more common than inpatient procedures. Inpatient surgical volume declined from 2000 to 2006, but it was not possible to evaluate trends in total volumes. In 2006, mean costs were approximately $6000 per admission. For inpatient procedures in 2004 and 2006, costs were higher for hypopharyngeal (vs isolated palate) surgery, in rural hospitals, and for patients who were younger, with greater medical comorbidity, and with primary Medicaid coverage. CONCLUSION: Surgical treatment is performed in 0.2 percent of all adults with OSA annually. Validation of the exploratory findings concerning procedure type and cost requires additional studies, ideally including adjustment for clinical factors.

Use of acupuncture in the treatment of sinus and nasal symptoms: results of a practitioner survey.

BACKGROUND: The use of complementary medicine is increasingly popular in the United States. The use of acupuncture and its efficacy in treating chronic sinus and nasal symptoms is not well studied. METHODS: Regional licensed acupuncturists (1516) were mailed our acupuncture and chronic sinus and nasal symptoms survey. RESULTS: Three hundred thirty-one surveys (22%) were returned. Ninety-nine percent of those who returned surveys reported treating patients with chronic sinus and nasal symptoms. On a five-point scale the mean perceived efficacy for the overall treatment of chronic sinus and nasal symptoms was 4.2. The mean cost of an acupuncture treatment course for chronic sinus and nasal symptoms was calculated to be dollar 730.00. CONCLUSION: Complementary medicine practitioners frequently use acupuncture in the treatment of patients with chronic sinus and nasal symptoms. Although practitioners report good efficacy using acupuncture to treat such patients, quantitative data are certainly needed to substantiate these self-reports.