Expenditures and Health Care Utilization Among Adults With Newly Diagnosed LowBack and Lower Extremity Pain
Expenditures and Health Care Utilization Among Adults With Newly Diagnosed LowBack and Lower Extremity Pain
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DOI：
10.1001/jamanetworkopen.2019.3676
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发表时间：
2019-05-01
影响因子：
13.8
通讯作者：
Ratliff, John K.
中科院分区：
文献类型：
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作者：
Kim, Lily H.;Vail, Daniel;Ratliff, John K.
腰痛（LBP）伴或不伴下肢疼痛（LEP）是寻求医疗护理的最常见原因之一。以前的研究调查了这一人群的成本，目标是接受手术的患者。鲜为人知的是谁不接受surgery. Occupitives的患者之间的卫生保健利用率评估使用的卫生保健资源LBP和LEP管理和分析相关costs.DESIGN，设置，和参与者这项队列研究采用了回顾性分析的商业数据库，包含住院和门诊数据超过75万人。参与者是2008年至2015年期间新诊断为LBP或LEP的美国成年人，没有红旗诊断，并且在诊断前未使用阿片类药物。分析日期为2018年10月6日至2019年3月7日。暴露新诊断的LBP或LEP。主要结局和指标主要结局是诊断后前6个月和12个月内的总护理费用，按患者是否接受脊柱手术分层。进行评估以确定未接受手术的患者是否按照保守性LBP和LEP管理的建议指南接受护理。使用不同的医疗保健服务所产生的费用进行了estimated.RESULTS一个新的LBP或LEP诊断（中位数[四分位数范围]年龄，47 [36-58]岁，1 373 076 [55.0%]女性）的成年患者共2 498 013人被确定。超过一半（55.7%）的人没有接受任何干预。只有1.2%的患者接受了手术，但他们占12个月总费用的29.3%（7.84亿美元）。98.8%未接受手术的患者的总护理费用为18亿美元。没有接受手术的患者经常接受护理，这是不符合LBP和LEP的临床指南32.3%，这些患者在30天内接受成像诊断和35.3%接受成像没有一个试验的物理therapy.Conclusions和相关性的研究结果表明，手术是罕见的新诊断的LBP和LEP的患者，但仍然是一个显着的驱动程序的支出。不接受手术的患者的早期成像也是医疗保健支出增加的主要驱动因素。在具有典型自限性条件的患者中避免成本给美国医疗保健系统造成相当大的经济负担。
IMPORTANCE Low 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.OBJECTIVES To assess use of health care resources for LBP and LEP management and analyze associated costs.DESIGN, SETTING, AND PARTICIPANTS This 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.EXPOSURES Newly diagnosed LBP or LEP.MAIN OUTCOMES AND MEASURES The 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.RESULTS A 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 RELEVANCE The 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.