{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T21:00:27Z","timestamp":1740171627274,"version":"3.37.3"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,3,29]],"date-time":"2016-03-29T00:00:00Z","timestamp":1459209600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic rhinosinusitis (<jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>) is a prevalent chronic inflammatory disease. The basis of a clinical diagnosis of <jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content> for primary care physicians (<jats:styled-content style=\"fixed-case\">PCP<\/jats:styled-content>s) is based upon the recognition of a symptom constellation that manifests with the disease. However, because the symptomatology of <jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content> may overlap with other diagnoses, the referral of patient to the most appropriate specialist may not always occur, leading to further delays in evaluation and treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Given the emphasis on improving the value of health care in Canada, a decision tree model was designed to evaluate whether an upfront computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) scan of the paranasal sinuses ordered by the <jats:styled-content style=\"fixed-case\">PCP<\/jats:styled-content> for a suspected case of <jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content> would be more cost\u2010effective when compared to symptom\u2010based specialist referral practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>\u2010based strategy resulted in the patient arriving at the most appropriate specialist 95% (\u00b15%) of the time while the symptom\u2010based referral strategy resulted in the patient arriving at the correct specialist 77% (\u00b118%) of the time. The incremental cost effectiveness ratio (<jats:styled-content style=\"fixed-case\">ICER<\/jats:styled-content>) for the <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>\u2010based strategy was $1522 per patient arriving at the correct specialist.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These results suggest that <jats:styled-content style=\"fixed-case\">PCP<\/jats:styled-content>s can improve the effectiveness of their referrals for <jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content> by utilising an upfront <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> referral strategy. However, it would create an additional cost of approximately $1500 per patient referred. Given these findings, the potential clinical benefits of using an upfront <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scan in the Canadian primary care setting should be further studied to determine the value of the additional money spent to improve the effectiveness of <jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content> referral.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12650","type":"journal-article","created":{"date-parts":[[2016,3,19]],"date-time":"2016-03-19T01:12:19Z","timestamp":1458349939000},"page":"782-787","source":"Crossref","is-referenced-by-count":3,"title":["Economic evaluation of a computed tomography directed referral strategy for chronic rhinosinusitis"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1857-7628","authenticated-orcid":false,"given":"S.J.","family":"Kilty","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010 Head and Neck Surgery The University of Ottawa Ottawa ON Canada"},{"name":"The Ottawa Hospital Research Institute (OHRI) Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Leung","sequence":"additional","affiliation":[{"name":"Royal Victoria Regional Health Centre Barrie ON Canada"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Rudmik","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Department of Surgery University of Calgary Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,3,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21847"},{"key":"e_1_2_7_3_1","first-page":"1","article-title":"Summary health statistics for U.S. adults: National Health Interview Survey, 2010","volume":"10","author":"Schiller J.S.","year":"2012","journal-title":"Vital. 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