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Patient Safety and Quality Improvement

(493) The Time Burden of Office Visits in Contemporary Pituitary Care

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio
Disclosure(s):
Rose Dimitroyannis, BA: No relevant relationships to disclose.
Neil Kondamuri, MD: No relevant relationships to disclose.


Introduction: In cancer care, patients experience “time toxicity” due to time-related consequences of treatment, including return visits, travel, and urgent care visits. Time toxicity associated with pituitary adenomas has not been explored. Thus, we sought to characterize time burden of office visits associated with diagnosis of pituitary adenoma between 2016 and 2019.

Methods: The IBM MarketScan Commercial Claims database was used to analyze office visits for primary diagnosis of pituitary adenoma in 2016. Descriptive characteristics were used to analyze this cohort’s additional new (Current Procedural Terminology (CPT) codes 99201-99205) and return visits (CPT codes 99211-99215) for primary, secondary, and tertiary diagnoses of pituitary adenoma between 2016 and 2019, stratified by provider type. One-way ANOVA and two-sample t-tests were used to examine number of visits, time in office, and yearly visit time (α=0.05). Time was defined as an average of CPT code time ranges. Analyses were performed in Stata version 17.

Results: In 2016, 2,099 patients received a primary diagnosis of pituitary adenoma. There were 8,490 additional visits for this cohort from 2016-2019, of which 892 (10.5%) were new and 7,598 (89.5%) were return. Of all new visits, the plurality (n=857; 29.3%) were with endocrinologists. The most billed new and return CPT codes were 99204 (n=1,470; 49.2%) and 99214 (n=3,994; 52.6%). The average return visit with otolaryngologists was significantly shorter than those with endocrinologists (27.8 minutes vs. 33.9 minutes, p< 0.001). Total time spent at visits decreased significantly each year, from a cohort mean of 113 minutes in 2016 to 69 minutes in 2019 (p < 0.001).

Conclusions: This is the first study to quantify time burden of office visits for pituitary care. We likely underestimate outpatient time toxicity pituitary adenoma patients face. These results may inform future studies that can help improve efficiency and access to pituitary care.