title: Use of advanced imaging technology and endoscopy for chronic rhinosinusitis varies by physician specialty.
abstract: BACKGROUND
  Patients with chronic rhinosinusitis are cared for by multiple specialties. Endoscopy and imaging are important diagnostic tools. However, because physicians vary in their access to imaging and endoscopy, testing may vary across specialties. The purpose of this  study is to characterize differences in use of imaging and endoscopy between physician specialties.
  
  
  METHODS
  Using data from the National Ambulatory Medical Care Survey, we identified adult visits with primary, secondary, and tertiary diagnoses of chronic rhinosinusitis  from 2005 through 2008. We measured rates of advanced radiographic imaging (CT, MRI, and PET) and office procedures. Logistic regression models were used to assess the bivariate and independent effects of patient, physician, and practice-level factors on use of advanced imaging and office  procedures.
  
  
  RESULTS
  There were nearly 51 million visits for diagnoses coded as chronic rhinosinusitis, representing an average of 12.7 million visits annually. Primary care providers saw the majority of these patients. Otolaryngologists used advanced radiographic imaging  at a rate higher than primary care physicians per outpatient visit (16.0% versus 1.93%; p < 0.001). Office procedures, performed almost exclusively (99.2%) by otolaryngologists, were performed at 24.5% of otolaryngology visits. Private insurance was significantly associated with a lower  use of advanced radiographic imaging (odds ratio, 0.54; 95% CI, 0.31-0.94) among otolaryngology visits, but no patient or provider-level variables were associated with office procedure use.
  
  
  CONCLUSIONS
  Radiographic imaging and office procedures are used at a higher  rate per outpatient visit by otolaryngologists than by primary care providers. Additional studies are needed to identify and characterize factors that contribute to these different rates of use.
authors.affiliation: Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan 48109, USA. pynnonen@umich.edu
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pynnonen
authors.forename: Giant
authors.initials: G
authors.lastname: Lin
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008511:Medicine; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012220:Rhinitis / Q000175:diagnosis*; D012852:Sinusitis / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed