Diagnosis, Treatment, & Service Utilization of Patients with Neck and Back Pain

在过去的十年中，介入脊柱手术的使用急剧增加，医疗保健费用不断上升，这引发了许多关于背部和颈部疼痛治疗的利用和结果的问题。有几篇文章讨论了与脊柱手术相关的一些情况，并报告了硬膜外类固醇注射后与类固醇使用相关的灾难性不良事件。 本研究的目的是描述和描述背部和颈部疼痛的治疗，同时检查时间和地理趋势，医生专业和设置变化。我们将描述新诊断的背部和颈部疼痛患者的治疗轨迹，并确定有效的治疗路径和潜在的高成本和利用率的途径。患者治疗路径的表征将包括手动和经皮治疗的跟踪、阿片类药物的使用、成像利用、外科手术和安全性事件。我们将通过跟踪患者术后至少一年来检查介入脊柱手术后的结局和不良事件。 确定有效和安全的背痛治疗途径将导致更好的背痛管理指南。对介入性脊柱手术的结果和副作用的描述将有助于患者和医生对治疗方案做出更明智的决定。 数据 本项目将使用两个数据集：2000-2011年间诊断为背痛的患者的医疗保险行政健康记录，以及其数据集中目前可用的诊断为背痛的患者的联合医疗保健行政健康记录和电子医疗记录。NIH和CMS之间已经建立了访问这些数据的合同。目前，NIH和Optum Labs正在制定一份访问联合医疗数据的合同。 自上一份年度报告以来，我们取得了以下成绩： 购买了一个访问CMS虚拟环境（CCW Enclave）的席位，该环境允许在CMS服务器上分析SAS中的CMS数据。 根据感兴趣的数据子集产生初步结果，并评估今后工作的可行性。在学术会议上提出初步成果。 向CMS提交了一份数据增补请求，CMS批准了该提案。 2000-2011年，为近4700万名诊断为背痛的患者获得CMS载体、住院患者、门诊患者和D部分文件。 开始与学术伙伴合作。 识别与我们的项目相关的诊断、程序、药物、并发症和结果的代码。 我们正在利用新的数据集复制初步结果。 向Optum Labs提交了一份项目提案，以访问United Healthcare数据并在其虚拟环境中工作;该提案已获得批准 目前正在与Optum Labs签订合同，以访问他们的数据和虚拟环境。

The dramatic increase in the use of interventional spine procedures and the rising health care costs over the past decade have raised lots of questions about the utilization and outcomes of treatments for back and neck pain. Several articles have addressed some concerning scenarios related to spinal surgeries, and catastrophic adverse events after epidural steroid injections have been reported, related to steroid use. The purpose of this study is to describe and characterize the treatment of back and neck pain, while examining temporal and geographical trends, physician specialty, and setting variations. We will characterize treatment trajectories in newly diagnosed back and neck pain patients, and identify efficient treatment paths and potential gateways to high cost and utilization. The characterization of patients treatment paths will include tracking of manual and percutaneous treatments, use of opioids, imaging utilization, surgical procedures, and safety events. We will examine the outcomes and adverse events following interventional spinal procedures by tracking patients for at least one year after their procedures. Identifying efficient and safe treatment paths for back pain will lead to better guidelines for back pain management. A characterization of the outcomes and side effects of interventional spinal procedures will help patients and physicians make more informed decisions about treatment options. Data Two datasets will be used for this project: Medicare administrative health records for patients diagnosed with back pain between 2000-2011, and United Healthcare administrative health records and electronic medical records for patients diagnosed with back pain currently available in their dataset. A contract to access this data has been established between NIH and CMS. A contract to access the United Healthcare data is currently being developed between NIH and Optum Labs. Since the previous annual report, we have achieved the following: Purchased a seat for access to a CMS virtual environment (CCW Enclave) that allows the analysis of CMS data in SAS, on CMS servers. Produced preliminary results based on a subset of the data of interest and evaluated the feasibility of future work. Presented preliminary results at academic conferences and meetings. Submitted a data addendum request to CMS, who approved the proposal. Obtained access to CMS Carrier, Inpatient, Outpatient, and Part D files for the years 2000-2011 for almost 47 million patients with diagnoses of back pain. Started collaborations with academic partners. Identified codes of diagnoses, procedures, drugs, complications, and outcomes relevant to our projects. We are in the process of replicating the preliminary results using the new data set. Submitted a project proposal to Optum Labs for accessing United Healthcare data and working in their virtual environment; the proposal has been approved Currently developing contract with Optum Labs for accessing their data and virtual environment.