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

在过去的十年里，脊柱介入性手术的使用急剧增加，医疗费用不断上升，这引发了许多关于背部和颈部疼痛治疗的使用和结果的问题。有几篇文章讨论了一些与脊柱手术相关的情景，以及已报道的与类固醇使用有关的硬膜外类固醇注射后的灾难性不良事件。 这项研究的目的是描述和描述背部和颈部疼痛的治疗特点，同时检查时间和地理趋势、医生专业和环境变化。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。患者治疗路径的特征将包括跟踪手动和经皮治疗、阿片类药物的使用、成像利用、外科手术和安全事件。我们将通过跟踪患者手术后至少一年的时间来检查介入脊柱手术后的结果和不良事件。 确定有效和安全的背痛治疗路径将导致更好的背痛管理指南。对介入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 该项目目前专注于2000-2013年间被诊断为背痛的患者的联邦医疗保险管理健康记录。NIH和CMS之间已经签订了访问这些数据的合同。 自上一次年度报告以来，我们取得了以下成就： 更新了我们访问CMS虚拟研究数据中心(VRDC)的席位，该中心允许在CMS服务器上分析SAS中的CMS数据。 根据感兴趣的数据的子集产生了初步结果，并评估了未来工作的可行性。在学术会议和会议上发表初步成果。 向CMS提交了数据增补请求，CMS批准了该提案。 获得了2000-2013年间近4700万确诊为背痛患者的CMS携带者、住院患者、门诊患者和D部分文件的访问权限。 与学术伙伴的持续合作。 确定与我们的项目相关的诊断、程序、药物、并发症和结果的代码。 在更新的数据集和队列上进行了额外的数据运行，重点是研究期间的患者人口统计和注射次数。根据类固醇类型和注射方法的不同并发症发生率正在进行检查。一项已发表的分析探讨了在一组腰椎滑脱症患者中使用注射、手术干预和物理治疗的情况。初步结果已在大轮次风格的会议上公布。 今年研究产生的出版物： Sclafani，JA，Constantin，A，Ho，PS，Akuthota，V，Chan，L.2000-2011年医疗保险受益人中退行性腰椎滑脱症的脊髓神经轴向注射、手术干预和物理治疗应用的描述性分析。脊柱2016年DOI：10.1097/BRS.0000000000001724

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 This project currently focuses on Medicare administrative health records for patients diagnosed with back pain between 2000-2013. A contract to access this data has been established between NIH and CMS. Since the previous annual report, we have achieved the following: Renewed our seat for access to a CMS virtual research data center (VRDC) 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 2000-2013 for almost 47 million patients with diagnoses of back pain. Continued collaborations with academic partners. Identified codes of diagnoses, procedures, drugs, complications, and outcomes relevant to our projects. Additional data runs have been conducted on the updated dataset and cohort that focus on patient demographics and numbers of injections over the period under study. Differential complication rates by steroid type and injection approach are being examined. A published analysis explored the use of injections, surgical interventions, and physical therapy utilization in a sub-cohort of patients with spondylolisthesis. Preliminary results have been presented at Grand Rounds style conferences. Publications generated by this year's research: Sclafani, JA, Constantin, A, Ho, PS, Akuthota, V, Chan, L. Descriptive Analysis of Spinal Neuroaxial Injections, Surgical Interventions and Physical Therapy Utilization for Degenerative Lumbar Spondylolisthesis within Medicare Beneficiaries from 2000-2011. Spine 2016 doi: 10.1097/BRS.0000000000001724