Geographic variation in epidural steroid injection use in medicare patients
Geographic variation in epidural steroid injection use in medicare patients
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DOI：
10.2106/jbjs.g.00858
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发表时间：
2008-08-01
影响因子：
5.3
通讯作者：
Deyo, Richard
中科院分区：
文献类型：
--
作者：
Friedly, Janna;Chan, Leighton;Deyo, Richard
背景资料：随着时间的推移，硬膜外类固醇注射的比例急剧增加，关于硬膜外类固醇注射治疗各种腰痛疾病的疗效存在相互矛盾的证据。鉴于其作用的不确定性，我们试图评估美国使用硬膜外类固醇注射治疗腰痛的地理差异。我们还试图确定是否更大的硬膜外类固醇注射率与较低的腰椎surgery.Methods率：我们使用了2001年医疗保险医生部分B索赔检查硬膜外类固醇注射使用的地理变化。使用当前手术技术代码来识别所执行的手术数量以及透视引导的注射百分比。使用几个地理指标分析手术率，包括州、美国人口普查局地区（东北部、南部、中西部和西部）以及达特茅斯卫生保健地图集定义的健康转诊区域。在二零零一年，与最低比率的州相比，（夏威夷为千分之5. 2）和发病率最高的州（亚拉巴马为千分之39. 9）。健康转诊地区之间的差异更大，这些地区面积较小，差异从夏威夷的檀香山的每1000人5. 6人到加州的棕榈泉的每1000人103. 6人，相差18. 4倍。全州范围内硬膜外类固醇注射率较高与腰椎手术率显著较高相关（p = 0.001）。在注射率高的地区，因腰痛寻求治疗的患者接受注射的比例明显较高（p < 0.001）。此外，在注射率高的地区，在同一年内接受注射和腰椎手术的腰痛患者比例明显较高（p < 0.001）。结论：美国硬膜外类固醇注射率存在很大的地理差异。南部各州的手术率往往最高，而东北部各州的手术率最低。注射率与腰椎手术率呈正相关;因此，硬膜外类固醇注射似乎并不能替代腰椎手术或降低腰椎手术的总体率。
Background: The rates of epidural steroid injections have increased dramatically over time, with conflicting evidence regarding the efficacy of epidural steroid injections for the treatment of various low-back pain disorders. Given the uncertainty about their role, we sought to evaluate the geographic variation in the use of epidural steroid injections for low back pain within the United States. We also sought to determine whether greater rates of epidural steroid injections are associated with lower rates of lumbar surgery.Methods: We used the 2001 Medicare Physician Part-B claims to examine the geographic variation in the use of epidural steroid injections. Current Procedural Technology codes were used to identify the number of procedures performed as well as the percentage of injections that were fluoroscopically guided. Procedure rates were analyzed with use of several geographic indicators, including state, United States Census Bureau regions (Northeast, South, Midwest, and West), and health referral regions as defined by the Dartmouth Atlas of Health Care.Results: In 2001, there was a 7.7-fold difference between the state with the lowest rate (Hawaii at 5.2 per 1000) and the state with the highest rate (Alabama at 39.9 per 1000). The variation among health referral regions, which are smaller in size, was even greater, with an 18.4-fold difference from 5.6 per 1000 in Honolulu, Hawaii, to 103.6 per 1000 in Palm Springs, California. Higher statewide rates of epidural steroid injections were associated with significantly higher rates of lumbar surgery (p = 0.001). In areas with high injection rates, a significantly higher percentage of patients who sought care for low back pain received injections (p < 0.001). In addition, in areas with high injection rates, a significantly higher percentage of patients who presented with low back pain received both injections and lumbar surgery within the same year (p < 0.001).Conclusions: There is substantial geographic variation in the rates of epidural steroid injections within the United States. Southern states tend to have the highest procedure rates, whereas northeastern states have the lowest. Injection rates are positively correlated with lumbar surgery rates; therefore, epidural steroid injections do not appear to be substituting for lumbar surgeries or reducing overall rates of lumbar surgery.