An electronic interface to routinize outcomes assessment and streamline clinic workflow

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Objective The 22-item Sinonasal Outcome Test (SNOT-22) is a trusted measure of symptom severity in chronic rhinosinusitis. The European Position Paper on Rhinosinusitis (EPOS) provides widely accepted diagnostic criteria, which include sinonasal symptoms, their duration, and imaging results. Our objective was to compare these approaches to assessing symptoms to determine if either was more indicative of radiologic findings, to support decisions in telehealth. Study Design Observational outcomes study. Setting Tertiary care center. Methods In total, 162 consecutive patients provided a structured sinonasal history, completed the SNOT-22, and underwent sinus computed tomography (CT) within 1 month. SNOT-22 scores, EPOS-defined symptom sets, and Lund-Mackay results were assessed. To facilitate direct comparisons, we performed stepwise evaluations of sinonasal symptoms alone and combined with duration. The discriminatory capacity for imaging results was determined through areas under the receiver operating characteristic curves (ROC-AUC) for dichotomous outcomes and ordinal regression for multilevel outcomes. Results In ROC-AUC analyses, SNOT-22 and EPOS-defined symptoms had similar discriminatory capacity for Lund-Mackay scores, regardless of duration. Within ordinal regression analyses, SNOT-22 nasal scores were significantly associated with Lund-Mackay scores, while EPOS-defined nasal symptoms were not statistically significantly related. Conclusions SNOT-22 nasal scores and EPOS-defined nasal symptoms may have similar associations with imaging results when assessed via ROC-AUC, while SNOT-22 may have more association within ordinal data. Understanding the implications of discrete patterns of symptoms may confer benefit, particularly when in-person and fiberoptic exams are limited.

Section: Discussionmentioning

confidence: 82%

The Sinonasal Outcome Test–22 or European Position Paper: Which Is More Indicative of Imaging Results?

Zhou

Prince

Maxfield

et al. 2020

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“…Now, we are developing more sophisticated methods to pursue prospective formalized data collection, as daily practice and planned quantitative assessment increasingly share a common arena. 38,39…”

Section: Discussionmentioning

confidence: 99%

Sinonasal Outcome Scores and Imaging: A Concurrent Assessment of Factors Influencing Their Association

Zhou

Prince

Maxfield

et al. 2020

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Objective The overall discriminatory ability of validated instrument scores for computed tomography (CT) findings of chronic rhinosinusitis has limitations and may be modified by multiple factors. To support optimal methods for assessment, we studied which factors could influence this relationship, including the concurrent impact of multiple discrete CT scoring mechanisms, colocalized imaging findings, and nasal comorbid conditions. Study Design Observational outcomes study. Setting Academic medical center. Methods Patients with sinonasal complaints who completed the 22-item Sinonasal Outcome Test (SNOT-22) and underwent CT were included. Multivariate ordinal regression was utilized to assess associations. CT data were quantified with the Lund-Mackay system, Zinreich system, and a direct measure of maximal mucosal thickness. The impact of incidental findings (mucous retention cysts, periapical dental disease) and nasal comorbid conditions was also assessed. Results A total of 233 patients were included. SNOT-22 nasal scores were significantly associated with CT results when those with incidental findings were excluded, regardless of the radiologic scoring mechanism utilized: Lund-Mackay regression coefficient, 0.321 ( P = .046); Zinreich, 0.340 ( P = .033); and maximum mucosal thickness, 0.316 ( P = .040). This relationship subsided when incidental findings were present. SNOT-22 overall scores, sleep scores, and psychological domain scores had no significant association with imaging results, regardless of radiologic scoring system utilized. Nasal comorbid conditions had inconsistent associations. Conclusions SNOT-22 nasal domain scores were associated with all 3 radiologic scoring systems when incidental findings were absent but not when they were present. Delineating the presence or absence of these colocalized findings affected the relationship between SNOT-22 scores and radiological results, beyond other concurrent factors.

“…There have been reports of additional means to streamline this process to minimize staff involvement and provider time investment through solely electronic interfaces that incorporate multiple related subspecialties in our field. 33 As we surmount the range of obstacles, PROM data can increasingly contribute to evidence-based practice, the foundational motivation for this article and series. [34][35][36][37][38] With regard to the spread of PROM collection, it would be beneficial to increase the availability of common, uniform PROMs that could be integrated into, and selected automatically from, electronic systems so that multiple providers, practices, and institutions could contribute to a shared or overlapping data set.…”

Section: Discussionmentioning

confidence: 99%

Evidence‐Based Medicine in Otolaryngology, Part 6: Patient‐Reported Outcomes in Clinical Practice

Carroll

Lee

Lindsay

et al. 2017

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The assessment of patient-reported outcome measures (PROMs) in the outpatient setting is gaining momentum in clinical and research venues. Implementing this data capture into one's practice, however, is not a one-size-fits-all venture, and it is critical to determine when, how, and where to include these patient-centered assessments. This installment of the "Evidence-Based Medicine in Otolaryngology" series provides insight into the implementation process and experiences with successful incorporation of PROMs into clinical practice. Specifically, 4 differing clinical scenarios and collection techniques are described, including data acquisition protocols, formats for clinician data usage, and applications of PROM results in clinical and research scenarios.