Care Choices and Costs for Low Back Pain

腰痛的护理选择和费用

• 批准号: 7215412
• 负责人: SYLVIA KUO
• 金额: $ 10万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-30 至 2008-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7215412
• 关键词: backache; chiropractic; clinical research; health care cost /financing; health care service utilization; health services research tag; human subject; human therapy evaluation; orthopedics; patient care management

DESCRIPTION (Provided by the Applicant): The widespread prevalence of low back pain (LBP) was associated with health care expenditures of $26.5 billion in the U.S. in 1998, as well as with 5.3 hours per week of lost productive work time. Most LBP cannot be attributed to any identifiable anatomic cause, and evidence-based guidelines for its treatment recommend both traditional and alternative therapies - such as spinal manipulation - prescribed by medical doctors (MDs) and doctors of chiropractic (DCs), respectively. Thus, understanding the cost tradeoffs between such therapies in the context of actual patient choice and provider practice patterns is crucial to identifying strategies that promote the efficient use of care for the treatment of acute LBP. Further, patient choice of whether an MD or DC is initially seen hinges on patient access to DCs, which previous research has not addressed. This proposal seeks to address these issues by using administrative claims data in 2004 from Blue Cross & Blue Shield of Rhode Island (BCBSRI), the dominant insurer in the state of Rhode Island. The specific aims of the study are to: [1] describe and compare the patterns of services received for patients with acute uncomplicated LBP episodes by speciality of the initial provider (if MD or DC) and whether a single or multiple providers are used; [2] evaluate the association between patient choice of initial provider type and access to DCs, and whether this choice differs by gender; and [3] evaluate the association between the cost of care per acute LBP episode and choice of initial provider controlling for patient demographic, clinical characteristics, and insurance coverage type, and by using local supply of chiropractors as an instrument to control for initial provider choice which may depend on unobserved LBP severity. Understanding the cost tradeoffs of recommended traditional versus alternative therapies for the treatment of LBP in a real-world setting may suggest that health plans could improve chiropractic coverage or limit the use of some types of services that may contribute to higher costs. Such strategies may help reduce the health care expenditures associated with LBP. The findings from this proposed research will lead to a larger study which would examine outcomes and costs.

描述（由申请人提供）：1998 年，腰痛 (LBP) 的广泛流行与美国 265 亿美元的医疗保健支出以及每周 5.3 小时的生产性工作时间损失相关。大多数腰痛不能归因于任何可识别的解剖学原因，基于证据的治疗指南推荐传统疗法和替代疗法，例如脊柱推拿，分别由医生 (MD) 和脊椎按摩医生 (DC) 处方。因此，在实际患者选择和提供者实践模式的背景下了解此类疗法之间的成本权衡对于确定促进有效利用护理治疗急性腰痛的策略至关重要。此外，患者选择首先看 MD 还是 DC 取决于患者能否接触 DC，而之前的研究尚未解决这一问题。该提案旨在通过使用罗德岛州主要保险公司 Blue Cross & Blue Shield (BCBSRI) 2004 年的行政索赔数据来解决这些问题。该研究的具体目的是： [1] 按初始提供者（如果是 MD 或 DC）的专业以及是否使用单个或多个提供者来描述和比较急性无并发症 LBP 发作患者所接受的服务模式； [2] 评估患者对初始提供者类型的选择与获得 DC 之间的关联，以及这种选择是否因性别而异； [3] 评估每次急性 LBP 发作的护理成本与控制患者人口统计、临床特征和保险范围类型的初始提供者选择之间的关联，并使用当地脊椎按摩师的供应作为控制初始提供者选择的工具这可能取决于未观察到的 LBP 严重程度。 了解在现实环境中治疗 LBP 的推荐传统疗法与替代疗法的成本权衡可能表明，健康计划可以提高脊椎按摩治疗的覆盖范围或限制使用某些可能导致更高成本的服务类型。这些策略可能有助于减少与 LBP 相关的医疗保健支出。这项拟议研究的结果将导致一项更大规模的研究，以检查结果和成本。