Healthcare utilisation, follow-up of guidelines and practice variation on rhinosinusitis in adults: A healthcare reimbursement claims study in The Netherlands.
OBJECTIVES
To provide insight into healthcare utilisation of rhinosinusitis, compare data with clinical practice guideline recommendations and assess practice variation.


DESIGN
Anonymised data from claims reimbursement registries of healthcare insurers were analysed, from 1 January 2016 until 31 December 2016.


SETTING
Secondary and tertiary care in the Netherlands.


PARTICIPANTS
Patients ≥18 years with diagnostic code "sinusitis."


MAIN OUTCOME MEASURES
Healthcare utilisation (prevalence, co-morbidity, diagnostic testing, surgery), costs, comparison with guideline recommendation, practice variation.


RESULTS
We identified 56 825 patients, prevalence was 0.4%. Costs were € 45 979 554-that is 0.2% of total hospital-related care costs (€21 831.3 × 106 ). Most patients were <75 years, with a slight female preponderance. 29% had comorbidities (usually COPD/asthma). 9% underwent skin prick testing, 61% nasal endoscopy, 2% X-ray and 51% CT. Surgery rate was 16%, mostly in daycare. Nearly, all surgical procedures were performed endonasally and concerned the maxillary and/or ethmoid sinus. Seven recommendations (25%) could be (partially) compared to the distribution of claims data. Except for endoscopy, healthcare utilisation patterns were in line with guideline recommendations. We compared results for three geographical regions and found generally corresponding rates of diagnostic testing and surgery.


CONCLUSION
Prevalence was lower than reported previously. Within the boundaries of guideline recommendations, we encountered acceptable variation in healthcare utilisation in Dutch hospitals. Health reimbursement claims data can provide insight into healthcare utilisation, but they do not allow evaluation of the quality and outcomes of care, and therefore, results should be interpreted with caution.
['Kaper|Nina M|NM|0000-0002-8849-8645', 'Aarts|Mark C J|MCJ|', 'Stokroos|Robert J|RJ|', 'van der Heijden|Geert J M G|GJMG|']
D015897:Comorbidity D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D009426:Netherlands D010342:Patient Acceptance of Health Care D017410:Practice Guidelines as Topic D012051:Reimbursement Mechanisms D012189:Retrospective Studies D012220:Rhinitis D012852:Sinusitis
healthcare utilisation practice guideline sinusitis prevalence costs clinical practice patterns clinical practice variation epidemiology evidence-based medicine evidence-based practice health expenditure health insurance reimbursement insurance claim reporting volumes