{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:17:58Z","timestamp":1788304678876,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,7,12]],"date-time":"2013-07-12T00:00:00Z","timestamp":1373587200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective analysis of a large, national administrative US claims database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 149,653 unique patients saw a PCP as an outpatient for a laryngeal\/voice disorder, with 136,152 (90.9%) only seeing a PCP, 6,013 (4.0%) referred by a PCP to an otolaryngologist, and 3,820 (2.6%) self\u2010referred to an otolaryngologist. Acute laryngitis had a lower hazard ratio (HR) for otolaryngology referral than chronic laryngitis, nonspecific dysphonia, and laryngeal cancer. Having multiple comorbid conditions was associated with 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 &lt;1 month to &gt;3 months. PCP\u2010referred patients had less time to the otolaryngology evaluation than self\u2010referred patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>2b. <jats:italic>Laryngoscope<\/jats:italic>, 124:214\u2013220, 2014<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.24280","type":"journal-article","created":{"date-parts":[[2013,6,22]],"date-time":"2013-06-22T07:48:37Z","timestamp":1371887317000},"page":"214-220","source":"Crossref","is-referenced-by-count":39,"title":["Factors influencing referral of patients with voice disorders from primary care to otolaryngology"],"prefix":"10.1002","volume":"124","author":[{"given":"Seth M.","family":"Cohen","sequence":"first","affiliation":[{"name":"Duke Voice Care Center, Division of Otolaryngology\u2013Head &amp; Neck Surgery Duke University Medical Center Durham North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaewhan","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Public Health &amp; Study Design and Biostatistics Center University of Utah Salt Lake City Utah U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Roy","sequence":"additional","affiliation":[{"name":"University of Utah Salt Lake City Utah U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Courey","sequence":"additional","affiliation":[{"name":"Duke Voice Care Center, Division of Otolaryngology\u2013Head &amp; Neck Surgery Duke University Medical Center Durham North Carolina U.S.A."},{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery University of California, San Francisco San Francisco California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,7,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22426"},{"key":"e_1_2_6_3_1","first-page":"2775","article-title":"Evaluating hoarseness: keeping your patient's voice health","volume":"57","author":"Rosen CA","year":"1998","journal-title":"Am Fam Physician"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/00325481.1984.11698734"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21058"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940611500209"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23189"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23197"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.3.261"},{"key":"e_1_2_6_10_1","first-page":"215","article-title":"Family physicians' referral decisions: results from the ASPN referral study","volume":"51","author":"Forrest CB","year":"2002","journal-title":"J Fam Pract"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.12.022"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348941212101001"},{"key":"e_1_2_6_13_1","first-page":"427","article-title":"Prevalence of health problems and primary care physicians' specialty referral decisions","volume":"50","author":"Forrest CB","year":"2001","journal-title":"J Fam Pract"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23630"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1021944123914"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23603"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1044\/1092-4388(2004\/042)"},{"key":"e_1_2_6_18_1","first-page":"147","article-title":"Gender differences in the utilization of health care services","volume":"49","author":"Bertakis K","year":"2000","journal-title":"J Fam Pract"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2000.04079.x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-59989570083-8"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.06.744"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2010.506375"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flary.24280","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.24280","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.24280","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.24280","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T19:22:22Z","timestamp":1692559342000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.24280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,7,12]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2014,1]]}},"alternative-id":["10.1002\/lary.24280"],"URL":"https:\/\/doi.org\/10.1002\/lary.24280","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,7,12]]}}}