Dataset Information

Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.

ABSTRACT:

Objective

Compare health care utilization and charges for low-back-pain (LBP) patients receiving advanced imaging or physical therapy as a first management strategy following a new primary care consultation.

Data source

Electronic medical record (EMR) and insurance claims data.

Study design

Retrospective analysis of propensity-matched groups.

Data collection/extraction

Claims and EMR data were used. Utilization and LBP-related charges over a 1-year period were extracted from claims data.

Principal findings

In the propensity-matched sample (n = 406), advanced imaging recipients had higher odds of all utilization outcomes. Charges were higher with advanced imaging by an average $4,793 (95 percent CI: $3,676, $5,910).

Conclusions

For patients with LBP whom newly consulted primary care referred for additional management, advanced imaging as a first management was associated with higher health care utilization and charges than physical therapy.

SUBMITTER: Fritz JM

PROVIDER: S-EPMC4693839 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.

Fritz Julie M JM Brennan Gerard P GP Hunter Stephen J SJ

Health services research 20150316 6

<h4>Objective</h4>Compare health care utilization and charges for low-back-pain (LBP) patients receiving advanced imaging or physical therapy as a first management strategy following a new primary care consultation.<h4>Data source</h4>Electronic medical record (EMR) and insurance claims data.<h4>Study design</h4>Retrospective analysis of propensity-matched groups.<h4>Data collection/extraction</h4>Claims and EMR data were used. Utilization and LBP-related charges over a 1-year period were extrac ...[more]

PMID: 25772625

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Project description:BackgroundLow back pain (LBP) is the most common medical cause of disability among adults 65 or older. No previous study has characterized health care costs and treatment patterns of LBP among Medicare beneficiaries.MethodsThis retrospective cohort study quantifies health care utilization costs among Medicare beneficiaries with newly diagnosed LBP, compares costs between patients managed operatively and nonoperatively, identifies costs associated with treatment guideline nonadherence, and characterizes opioid prescribing patterns. Patients were queried via ICD codes from a 20% random sample of Medicare claims records. Patients with concomitant or previous "red flag" diagnoses, neurological deficits, or diagnoses that could cause nondegenerative LBP were excluded. Total costs of care in the year of diagnosis were calculated and stratified by operative versus nonoperative management. To assess for guideline adherence, utilization and costs of different services were tabulated. Opioid prescription patterns were characterized by quantity, cost, duration, and medication type.ResultsAbout 1,269,896 patients were identified; 23,919 (1.8%) underwent surgery. These accounted for 7% of the cohort's total cost ($514 million total, $21,496 per person). Patients treated nonoperatively accounted for over $7 billion in costs ($5,880 per person; p<.001). Within the nonoperative cohort, 626,896 (50.3%) patients were nonadherent to current guidelines for conservative management of LBP. Guideline nonadherence increased total annual costs by $4,012 per person ($7,873 for nonadherent vs. $3,861 for adherent patients, p<.001). About 460,867 opioid prescriptions were filled for 303,796 unique patients (23.9%) within 30 days of LBP diagnosis. Within the nonsurgical cohort, patients nonadherent to imaging guidelines were more likely to have an opioid prescription within this window than adherent patients (26.5% vs. 21.2%; p<.001).ConclusionsNonoperative management of LBP is associated with significantly lower costs per patient. Early imaging and opioid prescription are significant drivers of excess cost. Adherence to proposed treatment guidelines can save over $2.8 billion in total health care costs.

Project description:Study designSecondary analysis of the Back Pain Outcomes using Longitudinal Data (BOLD) cohort study.ObjectiveTo characterize associations of self-reported race/ethnicity with back pain (BP) patient-reported outcomes (PROs) and health care utilization among older adults with a new episode of care for BP.Summary of background dataNo prior longitudinal studies have characterized associations between multiple race/ethnicity groups, and BP-related PROs and health care utilization in the United States.MethodsThis study included 5117 participants ≥65 years from three US health care systems. The primary BP-related PROs were BP intensity and back-related functional limitations over 24 months. Health care utilization measures included common diagnostic tests and treatments related to BP (spine imaging, spine-related relative value units [RVUs], and total RVUs) over 24 months. Analyses were adjusted for multiple potential confounders including sociodemographics, clinical characteristics, and study site.ResultsBaseline BP ratings were significantly higher for blacks vs. whites (5.8 vs. 5.0; P < 0.001). Participants in all race/ethnicity groups showed statistically significant, but modest improvements in BP over 24 months. Blacks and Hispanics did not have statistically significant improvement in BP-related functional limitations over time, unlike whites, Asians, and non-Hispanics; however, the magnitude of differences in improvement between groups was small. Blacks had less spine-related health care utilization over 24 months than whites (spine-related RVU ratio of means 0.66, 95% confidence interval [CI] 0.51-0.86). Hispanics had less spine-related health care utilization than non-Hispanics (spine-related RVU ratio of means 0.60; 95% CI 0.40-0.90).ConclusionBlacks and Hispanics had slightly less improvement in BP-related functional limitations over time, and less spine-related health care utilization, as compared to whites and non-Hispanics, respectively. Residual confounding may explain some of the association between race/ethnicity and health outcomes. Further studies are needed to understand the factors underlying these differences and which differences reflect disparities.Level of evidence3.

Project description:BackgroundChronic low back pain is a costly condition and the leading cause of disability worldwide. A recent call to action identified the overuse of low-value health care as ineffective and potentially harmful in the context of back pain. Interdisciplinary pain programs (IPPs) incorporate physical therapy and behavioral pain treatments with the goal of empowering patients to actively use skills to self-manage pain, decreasing stress, disability, and reliance on low-value care. While IPPs are deemed "cost-effective," few studies elaborate upon the patterns of healthcare utilizations among patients who complete IPPs with attention to valued-based care. The aim of this study was to describe healthcare patterns of patients participating in a interdisciplinary pain program (IPP) for chronic low back pain.MethodsThis observational cohort study describes the healthcare utilization of a group of adult patients (N=143) who participated in an IPP for chronic back pain compared to patients who did not complete the entire program (N=112), and those who were eligible for the program but chose not to participate (N=76). Patterns of healthcare utilization were evaluated in a 12-month period before and after IPP participation. Healthcare utilization categories included outpatient resources, specialist visits, imaging, pain interventional procedures, and acute care utilization. Opioid use was also extracted based on inpatient and outpatient orders, as well as days on opioids within 2 weeks following an emergency department visit or hospitalization. Utilization was defined as a health care visit in which the primary or secondary diagnosis or procedure reason was back pain related. Relative value units (RVUs) measure value used in Medicare reimbursement for physician services.ResultsOverall, healthcare utilization was not markedly different in the 12 months before and after IPP across the 3 groups (graduates, drop-outs, or no participation). However, sub-grouping analyses revealed significant reductions in opioid prescriptions, x-rays, and ED visits in the IPP group for the 12 months after the program, as well as an increased utilization of behavioral pain management.ConclusionsAdult patients who participated in an IPP for chronic low back pain demonstrated significant reductions in utilization in opioid prescriptions, x-rays and ED visits, while also showing increased participation in active therapies such as behavioral pain management. These findings suggest that participation in a IPP could influence future value-based healthcare decisions, in turn also influencing cost.

Project description:Aims and objectivesTo describe characteristics of service utilization by advanced practice nurses (APNs) employing an electronic consultation (eConsult) service in their care for older adults.BackgroundCanada's aging population is projected to place unprecedented demands on the healthcare system. APNs, which include clinical nurse specialists (CNSs) and nurse practitioners (NPs), are nurses with advanced knowledge who can independently provide age-appropriate care. eConsult is a secure web-based platform enabling asynchronous, provider-to-provider communication. APNs can send and receive eConsults to address patient-specific concerns.MethodsThis is a retrospective analysis of eConsult utilization and user survey data for cases completed in 2019, reported in line with the STROBE guidelines. Eligible eConsults included those that had APN involvement (as a referrer or responder) and were concerning an older patient (≥65 years). Descriptive statistics were used to analyse service utilization and survey response data.ResultsOf 430 eligible eConsults, 421 (97.9%) were initiated by NPs and the rest by physicians. 23 (5.3%) were received by a CNS, of which 14 (3.3%) involved an NP-to-CNS exchange. Median specialist response interval was 0.9 days. 53% of eConsults was for dermatology, haematology, cardiology, gastroenterology and endocrinology. 73% of eConsults avoided a face-to-face referral after the consultation. In 90% of eConsults, APNs rated the service as helpful and/or educational.ConclusionsThrough eConsult, APNs can collaborate with each other and physicians to access and provide a breadth of advice facilitating timely specialist-informed care for older patients, thus helping to alleviate some of the demands placed on the healthcare system.Relevance to clinical practiceThere is an opportunity for APNs to further adopt eConsult into their clinical practice, and this can, in turn, support the integration of the APN role in the health workforce.Patient or public contributionCurrent APN eConsult users were involved in the study design and interpretation of results.

Project description:ImportanceLow back pain (LBP) with or without lower extremity pain (LEP) is one of the most common reasons for seeking medical care. Previous studies investigating costs in this population targeted patients receiving surgery. Little is known about health care utilization among patients who do not undergo surgery.ObjectivesTo assess use of health care resources for LBP and LEP management and analyze associated costs.Design, setting, and participantsThis cohort study used a retrospective analysis of a commercial database containing inpatient and outpatient data for more than 75 million individuals. Participants were US adults who were newly diagnosed with LBP or LEP between 2008 and 2015, did not have a red-flag diagnosis, and were opiate naive prior to diagnosis. Dates of analysis were October 6, 2018, to March 7, 2019.ExposuresNewly diagnosed LBP or LEP.Main outcomes and measuresThe primary outcome was total cost of care within the first 6 and 12 months following diagnosis, stratified by whether patients received spinal surgery. An assessment was performed to determine whether patients who did not undergo surgery received care in accordance with proposed guidelines for conservative LBP and LEP management. Costs resulting from use of different health care services were estimated.ResultsA total of 2 498 013 adult patients with a new LBP or LEP diagnosis (median [interquartile range] age, 47 [36-58] years; 1 373 076 [55.0%] female) were identified. More than half (55.7%) received no intervention. Only 1.2% of patients received surgery, but they accounted for 29.3% of total 12-month costs ($784 million). Total costs of care among the 98.8% of patients who did not receive surgery were $1.8 billion. Patients who did not undergo surgery frequently received care that was inconsistent with clinical guidelines for LBP and LEP: 32.3% of these patients received imaging within 30 days of diagnosis and 35.3% received imaging without a trial of physical therapy.Conclusions and relevanceThe findings suggest that surgery is rare among patients with newly diagnosed LBP and LEP but remains a significant driver of spending. Early imaging in patients who do not undergo surgery was also a major driver of increased health care expenditures. Avoidable costs among patients with typically self-limited conditions result in considerable economic burden to the US health care system.

Dataset Information

Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.

Objective

Data source

Study design

Data collection/extraction

Principal findings

Conclusions

Publications

Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.

Similar Datasets

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