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，美国的医疗保健支出为265亿美元，以及每周损失的生产力工作时间5.3小时。大多数LBP不能归因于任何可识别的解剖学原因，以及其治疗方法的基于证据的指南建议分别由医生医生（MDS）和脊医医生（DCS）开出的传统和替代疗法（例如脊柱操纵）。因此，在实际的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至关重要，这对于确定促进有效利用护理急性LBP治疗的策略至关重要。此外，患者选择MD还是DC最初是在患者进入DC方面取决于以前的研究尚未解决的。该提案旨在通过2004年在罗德岛州的主要保险公司Rhode Island的Blue Cross＆Blue Shield（BCBSRI）中使用行政索赔数据来解决这些问题。该研究的具体目的是：[1]描述并比较了最初提供商（如果是MD或DC）的专业人士（如果使用MD或DC）为急性简单LBP发作的患者获得的服务模式，以及是否使用了单个或多个提供者； [2]评估患者选择初始提供者类型和对DC的访问之间的关联，以及该选择是否因性别而异； [3]评估每个急性LBP发作的护理成本与选择对患者人口统计学，临床特征和保险范围类型的最初提供者的选择，以及使用局部脊椎按摩师作为控制初始提供商选择的工具，这可能取决于未观察到的LBP LBP严重程度。 了解在现实环境中推荐的传统疗法和替代疗法的成本折衷可能表明，健康计划可以改善脊骨疗法的覆盖范围或限制某些可能导致更高成本的服务的使用。这种策略可能有助于减少与LBP相关的医疗保健支出。这项拟议的研究的发现将导致一项更大的研究，该研究将检查结果和成本。