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

诊断、治疗、

• 批准号: 9354080
• 负责人: Leighton Chan
• 金额: --
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9354080
• 关键词: Addendum; Address; Adverse effects; Adverse event; Annual Reports; Back Pain; Code; Collaborations; Complication; Contracts; Data; Data Set; Diagnosis; Event; Future; Guidelines; Health Care Costs; Image; Injection of therapeutic agent; Inpatients; Lead; Manuals; Medicare; Neck Pain; Newly Diagnosed; Operative Surgical Procedures; Outcome; Outpatients; Pain management; Patients; Pharmaceutical Preparations; Physical therapy; Physicians; Procedures; Publications; Publishing; Reporting; Research; Running; Safety; Spinal; Spine surgery; Spondylolisthesis; Steroids; Treatment outcome; United States National Institutes of Health; Update; Variant; Vertebral column; Work; base; beneficiary; cohort; cost; data access; demographics; health record; interest; medical specialties; meetings; opioid use; service utilization; symposium; trend; virtual

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

过去十年中，介入性脊柱手术的使用急剧增加，加上医疗保健成本不断上升，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。有几篇文章讨论了与脊柱手术相关的一些情况，以及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的报道。 本研究的目的是描述和表征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高成本和利用率的潜在途径。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、手术程序和安全事件。我们将通过在手术后跟踪患者至少一年来检查介入脊柱手术后的结果和不良事件。 确定有效且安全的背痛治疗途径将为背痛管理提供更好的指南。介入脊柱手术的结果和副作用的表征将帮助患者和医生就治疗方案做出更明智的决定。 数据 该项目目前重点关注 2000 年至 2013 年间诊断为背痛的患者的 Medicare 行政健康记录。 NIH 和 CMS 之间已签订了访问此数据的合同。 自上一份年度报告以来，我们取得了以下成果： 更新了访问 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。 根据感兴趣的数据子集得出初步结果，并评估未来工作的可行性。在学术会议和会议上展示了初步结果。 向 CMS 提交了数据附录请求，CMS 批准了该提案。 获得了 2000 年至 2013 年近 4700 万诊断背痛患者的 CMS 运营商、住院患者、门诊患者和 D 部分文件的访问权限。 继续与学术伙伴合作。 与我们的项目相关的诊断、手术、药物、并发症和结果的确定代码。 已对更新的数据集和队列进行了额外的数据运行，重点关注研究期间的患者人口统计数据和注射次数。正在检查不同类固醇类型和注射方法的不同并发症发生率。一项已发表的分析探讨了脊椎滑脱患者亚组中注射、手术干预和物理治疗的使用情况。初步结果已在大型回合式会议上公布。 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柱神经轴注射、手术干预和物理治疗利用的描述性分析。脊柱 2016 doi: 10.1097/BRS.0000000000001724