title: Emergency department presentation for uncomplicated acute rhinosinusitis is associated with poor access to healthcare.
abstract: OBJECTIVE
  Uncomplicated acute rhinosinusitis (ARS) is most appropriately managed in an outpatient clinic setting. Some ARS patients present to emergency departments (EDs) for care. We investigates factors associated with ARS presentation to EDs versus outpatient settings.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A total of 17,122,551 pediatric and adult patient visits from the 2009 and 2010 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys for ARS were identified. Patients with ARS complications were excluded. Univariate and multivariate associations identified demographic and socioeconomic characteristics of ARS patients independently associated with ED presentation. Temperature >100°F was used as a proxy for ARS severity.
  
  
  RESULTS
  Patients with Medicaid (odds ratio [OR] = 10.82, P < .001) or no insurance (OR = 9.14, P < .001) more likely presented to EDs when compared to patients with private insurance or Medicare. Independently, black patients (OR = 6.01, P < .001) more likely presented to EDs when compared to white or Hispanic patients. No significant association was seen with metropolitan or socioeconomic status based upon the patients' home zip code.
  
  
  CONCLUSIONS
  Presentation of ARS patients to EDs is associated with health insurance type and patient race independent of socioeconomic status. Healthcare access appears to be a primary determinant of whether patients present to an ED or outpatient setting for this common health problem. The association between race and ED presentation suggests cultural underpinnings requiring further characterization. Reducing barriers to care, for example through broader health insurance coverage, may enhance access to outpatient care providers and decrease costs associated with unnecessary ED presentation.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: George A
authors.initials: GA
authors.lastname: Scangas
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Regan W
authors.initials: RW
authors.lastname: Bergmark
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.|Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cunningham
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
mesh_terms: D000208:Acute Disease; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D012220:Rhinitis; D012852:Sinusitis
keywords: Health policy; allergy; clinical; cost effectiveness; outcomes; rhinology