Abstract：
BACKGROUND: The concept of \"time toxicity\" has emerged to address the impact of time spent in the healthcare system; however, little work has examined the phenomenon in the field of otolaryngology.
OBJECTIVE: To validate the use of Evaluation and Management (E/M) current procedural terminology codes as a method to assess time burden and to pilot this tool to characterize the time toxicity of office visits associated with a diagnosis of pituitary adenoma between 2016 and 2019.
METHODS: A retrospective cohort study of outpatient office visits quantified differences between timestamps documenting visit length and their associated E/M code visit length. The IBM MarketScan database was queried to identify patients with a diagnosis of pituitary adenoma in 2016 and to analyze their new and return claims between 2016 and 2019. One-way ANOVA and two-sample t-tests were used to examine claim quantity, time in office, and yearly visit time.
RESULTS: In the validation study, estimated visit time via E/M codes and actual visit time were statistically different (P < 0.01), with E/M codes underestimating actual time spent in 79.0% of visits. In the MarketScan analysis, in 2016, 2099 patients received a primary diagnosis of pituitary adenoma. There were 8490 additional-related claims for this cohort from 2016 to 2019. The plurality of new office visits were with endocrinologists (n = 857; 29.3%). Total time spent in office decreased yearly, from a mean of 113 min (2016) to 69 min (2019) (P < 0.001).
CONCLUSIONS: E/M codes underestimate the length of outpatient visits; therefore, time toxicity experienced by pituitary patients may be greater than reported. Further studies are needed to develop additional assessment tools for time toxicity and promote increased efficiency of care for patients with pituitary adenomas.
OBJECTIVE: To validate the use of Evaluation and Management (E/M) current procedural terminology codes as a method to assess time burden and to pilot this tool to characterize the time toxicity of office visits associated with a diagnosis of pituitary adenoma between 2016 and 2019.
METHODS: A retrospective cohort study of outpatient office visits quantified differences between timestamps documenting visit length and their associated E/M code visit length. The IBM MarketScan database was queried to identify patients with a diagnosis of pituitary adenoma in 2016 and to analyze their new and return claims between 2016 and 2019. One-way ANOVA and two-sample t-tests were used to examine claim quantity, time in office, and yearly visit time.
RESULTS: In the validation study, estimated visit time via E/M codes and actual visit time were statistically different (P < 0.01), with E/M codes underestimating actual time spent in 79.0% of visits. In the MarketScan analysis, in 2016, 2099 patients received a primary diagnosis of pituitary adenoma. There were 8490 additional-related claims for this cohort from 2016 to 2019. The plurality of new office visits were with endocrinologists (n = 857; 29.3%). Total time spent in office decreased yearly, from a mean of 113 min (2016) to 69 min (2019) (P < 0.001).
CONCLUSIONS: E/M codes underestimate the length of outpatient visits; therefore, time toxicity experienced by pituitary patients may be greater than reported. Further studies are needed to develop additional assessment tools for time toxicity and promote increased efficiency of care for patients with pituitary adenomas.
摘要：
背景：“时间毒性”的概念已经出现，以解决在医疗保健系统中花费时间的影响；但是，很少有工作研究耳鼻喉科领域的现象。
目的：验证使用评估和管理（E/M）当前程序术语代码作为评估时间负担的方法，并试用该工具来表征与2016年至2019年之间垂体腺瘤诊断相关的办公室就诊的时间毒性。
方法：一项门诊就诊的回顾性队列研究，量化了记录就诊长度的时间戳与相关E/M代码就诊长度之间的差异。对IBMMarketScan数据库进行了查询，以确定2016年诊断为垂体腺瘤的患者，并分析他们在2016年至2019年之间的新索赔和退货索赔。采用单因素方差分析和双样本t检验对索赔数量进行检验，时间在办公室,每年的访问时间。
结果：在验证研究中，通过E/M代码估计的访问时间和实际访问时间差异有统计学意义(P<0.01)，E/M代码低估了79.0%的访问所花费的实际时间。在MarketScan分析中，2016年,2099例患者接受了垂体腺瘤的初步诊断.从2016年到2019年，该队列有8490项额外的相关索赔。许多新的办公室访问是内分泌学家（n=857；29.3％）。在办公室花费的总时间逐年减少，从平均113分钟（2016年）到69分钟（2019年）（P<0.001）。
结论：E/M代码低估了门诊就诊的时间；因此，垂体患者经历的时间毒性可能大于报告。需要进一步的研究来开发额外的时间毒性评估工具，并提高垂体腺瘤患者的护理效率。
目的：验证使用评估和管理（E/M）当前程序术语代码作为评估时间负担的方法，并试用该工具来表征与2016年至2019年之间垂体腺瘤诊断相关的办公室就诊的时间毒性。
方法：一项门诊就诊的回顾性队列研究，量化了记录就诊长度的时间戳与相关E/M代码就诊长度之间的差异。对IBMMarketScan数据库进行了查询，以确定2016年诊断为垂体腺瘤的患者，并分析他们在2016年至2019年之间的新索赔和退货索赔。采用单因素方差分析和双样本t检验对索赔数量进行检验，时间在办公室,每年的访问时间。
结果：在验证研究中，通过E/M代码估计的访问时间和实际访问时间差异有统计学意义(P<0.01)，E/M代码低估了79.0%的访问所花费的实际时间。在MarketScan分析中，2016年,2099例患者接受了垂体腺瘤的初步诊断.从2016年到2019年，该队列有8490项额外的相关索赔。许多新的办公室访问是内分泌学家（n=857；29.3％）。在办公室花费的总时间逐年减少，从平均113分钟（2016年）到69分钟（2019年）（P<0.001）。
结论：E/M代码低估了门诊就诊的时间；因此，垂体患者经历的时间毒性可能大于报告。需要进一步的研究来开发额外的时间毒性评估工具，并提高垂体腺瘤患者的护理效率。
