Analysis of Online Patient Education Materials on Rhinoplasty.

Objective: Are education materials available online appropriate for patients seeking information before rhinoplasty? Study Design: Google.com and YouTube.com were searched for patient education information on rhinoplasty procedures. Of the first 100 results, 75 articles and 75 videos met the inclusion criteria. Each article's readability was scored using six previously validated readability scores to determine patient's ability to comprehend the text, while each video was scored using the Journal of the American Medical Association (JAMA) benchmark criteria and the Global Quality Score (GQS) to measure source reliability and educational value, respectively. Results: Analysis of the readability of the 75 articles yielded an average grade reading level of 10.31 (range 5-20; 95% confidence interval, 9.83-10.79), while video analysis found videos authored by physicians were significantly more reliable (PJAMA < 0.001) and had a significantly higher educational value (PGQS < 0.001). Patient education videos were found to be more reliable than patient experience videos (PJAMA = 0.01). Conclusions: The average reading level for text information on rhinoplasty is higher than the recommended 5th-grade reading level and educational videos authored by physicians are more reliable and contain higher educational value yet lack important information.

Distribution of Paycheck Protection Program to otolaryngology practices during the COVID-19 pandemic.

BACKGROUND: The Coronavirus disease of 2019 (COVID-19) has impacted physician practices in many ways with some ENT clinics reporting around a 50% drop in completed scheduled ENT visits during the first wave of the pandemic compared to 2019. AIMS: This study surveyed first round PPP loan disbursement to otolaryngology practices in the United States in response to COVID-19. METHODS: A cross-sectional study was conducted using publicly available data published on PPP by the SBA. Otolaryngology clinics receiving loans greater than $0.15M were filtered using the following terms: "otolaryngology", "otolaryngologist","sinus", "head and neck", "throat", "ENT", and "facial plastic". 481 ENT clinics that received loans greater than $0.15 M from the Paycheck Protection Program (PPP) were identified. Loan amount, business type, geographicregion, owner race, owner gender, and the number of jobs per business were recorded for each clinic. Chi-square analysis was performed to determine significance (P < 0.05) of each characteristic. RESULTS: Loan distribution was significantly different based on jobs reported (P < .001) and business type (P < .001). 100% of loans ranging from $0.15 M to $0.35 M went to micro and small practices whereas 33% of medium-sized practices received loans greater than $1 M. Higher proportions of Subchapter corporations (60.00%) received smaller loans of $0.15 to $0.35 M than Limited Liability Companies (39.13%) and Corporations (51.69%) which generally employ more people. DISCUSSION: Loan distribution was significantly different between businesses based on jobs reported (P < 0.001), with micro/small practices recieving smaller loans than their medium counterparts. All large businesses recived loans in in excess of $2 M. This suggests proportional distribution of loans in accordance with jobs reported. CONCLUSION: This study suggests PPP funding was objectively distributed to ENT clinics based on staff size. LEVEL OF EVIDENCE: Level 4.

Association of for-profit hospital ownership status with intracranial hemorrhage outcomes and cost of care.

OBJECTIVE: Much of the current discourse surrounding healthcare reform in the United States revolves around the role of the profit motive in medical care. However, there currently exists a paucity of literature evaluating the effect of for-profit hospital ownership status on neurological and neurosurgical care. The purpose of this study was to compare inpatient mortality, operation rates, length of stay, and hospital charges between private nonprofit and for-profit hospitals in the treatment of intracranial hemorrhage. METHODS: This retrospective cohort study utilized data from the National Inpatient Sample (NIS) database. Primary outcomes, including all-cause inpatient mortality, operative status, patient disposition, hospital length of stay, total hospital charges, and per-day hospital charges, were assessed for patients discharged with a primary diagnosis of intracranial (epidural, subdural, subarachnoid, or intraparenchymal) hemorrhage, while controlling for baseline demographics, comorbidities, and interhospital differences via propensity score matching. Subgroup analyses by hemorrhage type were then performed, using the same methodology. RESULTS: Of 155,977 unique hospital discharges included in this study, 133,518 originated from private nonprofit hospitals while the remaining 22,459 were from for-profit hospitals. After propensity score matching, mortality rates were higher in for-profit centers, at 14.50%, compared with 13.31% at nonprofit hospitals (RR 1.09, 95% CI 1.00-1.18; p = 0.040). Surgical operation rates were also similar (25.38% vs 24.42%; RR 0.96, 95% CI 0.91-1.02; p = 0.181). Of note, nonprofit hospitals appeared to be more intensive, with intracranial pressure monitor placement occurring in 2.13% of patients compared with 1.47% in for-profit centers (RR 0.69, 95% CI 0.54-0.88; p < 0.001). Discharge disposition was also similar, except for higher rates of absconding at for-profit hospitals (RR 1.59, 95% CI 1.12-2.27; p = 0.018). Length of stay was greater among for-profit hospitals (mean ± SD: 7.46 ± 11.91 vs 6.50 ± 8.74 days, p < 0.001), as were total hospital charges ($141,141.40 ± $218,364.40 vs $84,863.54 ± $136,874.71 [USD], p < 0.001). These findings remained similar even after segregating patients by subgroup analysis by hemorrhage type. CONCLUSIONS: For-profit hospitals are associated with higher inpatient mortality, lengths of stay, and hospital charges compared with their nonprofit counterparts.