Insurance status and quality of outpatient care for uncomplicated acute rhinosinusitis

IMPORTANCE: Previous work suggests an association between insurance status and location of presentation (emergency department vs outpatient clinic) for evaluation of uncomplicated acute rhinosinusitis (ARS). OBJECTIVE: To investigate whether the quality of outpatient care for ARS likewise differs based on insurance status. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 13 680 145 pediatric and adult patients from the 2009 and 2010 National Ambulatory Medical Care Survey diagnosed with uncomplicated ARS at an outpatient care facility. EXPOSURES: Health insurance status. MAINOUTCOMES ANDMEASURES: The primary outcome measures were continuity ofcare with the patients' primary care physician (PCP) and time spent with a physician, which were chosen as proxies for quality of care. We evaluated associations between insurance status and these quality measures while controlling for clinical, demographic and socioeconomic patient characteristics, and outpatient practice setting. RESULTS: Most patients (76.4%) had private insurance vs Medicare (12.3%), Medicaid (8.6%), or self-pay (2.8%). There was no association between insurance status and presentation of patients to their PCP. Physicians spent more time with Medicaid patients compared with patients with private insurance (β = 4.59; P =.01), independent of other factors. Provision of health education (β = 4.42; P <.001), necessity of a follow-up visit (β = 3.20; P =.002), and increasing patient age (β = 0.07; P =.01) were associated with longer visits. In multivariate analysis, living in a medium or small metropolitan area was associated with higher likelihood of being seen by one's own PCP than living in a large metropolitan area (odds ratio, 6.37; 95% CI, 2.13-19.05; P =.001). CONCLUSIONS AND RELEVANCE: This study did not identify any quality of care issues with respect to insurance coverage and primary care encounters for patients with ARS. In contrast to expectations, patients with Medicaid had longer outpatient physician visits and were equally likely to see their own PCP compared with patients with private insurance or Medicare.