PROCESSES OF CARE AND OUTCOMES IN CHRONIC RHINOSINUSITIS

University Of California Los Angeles, Los Angeles CA

Investigators

Abstract

Dr. Chin is an otolaryngologist-head and neck surgeon completing his second year at the UCLA/RAND Clinical Scholars Program. The K08 Award would allow him to meet his short-term goals of starting an academic career as one of a few formally trained health services researcher/head and neck surgeons in the country. The well-established health services research environment at UCLA and at RAND would be the ideal environment for him to pursue his training to the doctoral level with aims of eventually becoming an independent health services researcher. His career development plan includes a comprehensive educational Program detailing advanced doctoral level courses at UCLA and at RAND in health services research methodology combined with his KO8 research project under the continued mentorship of Dr. Katherine Kahn. The KO8 training opportunity will allow him to acquire advanced health services research skills necessary to position himself to make significant contributions to improve the quality of care and outcomes for patients with otolaryngologic diseases. His research proposal addresses chronic rhinosinusitis that was the most common chronic condition reported by outpatients in the 1995 National Health Interview Study (NHIS). As a Clinical Scholar, Dr. Chin conducted over 20 focus group meetings with patients with chronic rhinosinusitis drawn from the UCLA Primary Care Network with a demographic profile similar to the patients reporting chronic rhinosinusitis in the 1995 NHIS. The recent 1999 AHCPR evidence based report on the diagnosis and treatment of sinusitis cited the lack of existing evidence to support specific diagnostic or treatment measures for patients with rhinosinusitis. Consequently, care for rhinosinusitis is currently based on different, and at times conflicting, national consensus-based guidelines. Dr. Chin's research proposal is a prospective study of adult patients with chronic rhinosinusitis to assess variations in care and their relationship to outcomes in terms of disease severity and health related quality of life measured at 6 and 12-month follow-up. This will involve the application of the principles of process and outcomes of care. Processes are defined according to whether patients receive evidence-based measures of care and may include measures derived from different consensus-based clinical guidelines. The analyses of process measures and outcomes will be performed stratified and unstratified according to baseline disease severity. Disease severity is defined according to the chronicity, duration, frequency and severity of rhinosinusitis episodes. The findings of the proposal study will provide the basis for understanding patient outcomes in chronic rhinosinusitis in terms of the process of care that patient's receive and explicit disease severity measures. The research skills learned in the process of completing the K08 award will be invaluable and will position him to begin addressing the multitude of fascinating research topics at the interface of health care quality research and diseases of the head and neck.