Conclusion

Outcomes management in sinus surgery provides a model for outcomes measurement and management of many ambulatory conditions. Measurement demonstrates the relative burden of disease and the efficacy of therapy. By including cost as an outcome and understanding the relationship between health status and cost, economic models can be developed to demonstrate the relative value of procedures on the overall cost of chronic disease. The single most important cause of current controversy surrounding outcomes measures for sinus disease and surgery stems from attempts to force standardization, rather than evaluating each measurement system or staging system on its relative value for a particular purpose. An improved understanding of outcomes measures will enable clinicians and researchers to choose the approach that best suits their needs.

Sinusitis Health Status: PS

Sinusitis Health Status: PS

Health Domain

Chronic Sinusitis Survey: PS

S 100

If s

g SO

S 100

If s

g SO

Symptoms Medications CSS Total

Figure 18-2 (A) Sinusitis Health Status results including the Chronic Sinusitis Survey (CSS) and the SF-36 Health Survey demonstrate that patients can have near-normal SF-36 scores while still demonstrating significant decrements in sinus-specific health. After surgery, this symptomatic patient with pansinus disease and nasal polyps reaches the normative level for general health (GH) and maintains that level for all other subscales of the SF-36. This patient shows significant improvement in the total CSS score but does not reach normative levels. (B) A closer look at the breakdown of the CSS scores demonstrates significant improvement in the CSS total score, which is mostly due to the improvement in the CSS symptom score. Improvements in medication usage score are more modest in this patient, who has continued to use nasal steroid sprays and antihistamines.

Symptoms Medications CSS Total

Figure 18-2 (A) Sinusitis Health Status results including the Chronic Sinusitis Survey (CSS) and the SF-36 Health Survey demonstrate that patients can have near-normal SF-36 scores while still demonstrating significant decrements in sinus-specific health. After surgery, this symptomatic patient with pansinus disease and nasal polyps reaches the normative level for general health (GH) and maintains that level for all other subscales of the SF-36. This patient shows significant improvement in the total CSS score but does not reach normative levels. (B) A closer look at the breakdown of the CSS scores demonstrates significant improvement in the CSS total score, which is mostly due to the improvement in the CSS symptom score. Improvements in medication usage score are more modest in this patient, who has continued to use nasal steroid sprays and antihistamines.

REFERENCES

Gliklich—CHAPTER 18

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