The Cost Effectiveness of Complementary and Alternative Treatments to Reduce Pain

减少疼痛的补充和替代治疗的成本效益

• 批准号: 8755209
• 负责人: STEPHANIE L TAYLOR
• 金额: --
• 依托单位: SEPULVEDA RESEARCH CORPORATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8755209
• 关键词: Acupuncture Therapy; Address; Adherence; Anxiety; Back; Biofeedback; Characteristics; Chronic; Code; Comorbidity; Complementary and alternative medicine; Data; Data Analyses; Data Set; Databases; Degenerative Disorder; Degenerative polyarthritis; Diagnosis; Disease; Effectiveness; Feedback; Freedom; Goals; Guided imagery; Health Care Costs; Healthcare; ICD-9; Individual; Inflammatory; Medical Records; Mental Depression; Mental Health; Methods; Modality; Modeling; Muscle relaxation phase; Musculoskeletal; Musculoskeletal Pain; Natural Language Processing; Neck; Numeric Rating Scale; Opioid; Outpatients; Pain; Pain management; Patient Self-Report; Patients; Policies; Population; Post-Traumatic Stress Disorders; Primary Health Care; Recommendation; Relaxation Therapy; Reporting; Research; Resources; Services; Site; Sleep disturbances; Substance abuse problem; Traumatic Brain Injury; United States Department of Veterans Affairs; Variant; Veterans; War; alternative treatment; base; cohort; cost; cost effectiveness; data mining; health care service utilization; innovation; mindfulness meditation; operation; opioid use; public health relevance; stress management; treatment as usual

DESCRIPTION (provided by applicant): The goal of the proposed research is to examine the cost effectiveness of complementary and alternative medicine (CAM) in reducing musculoskeletal (MSD)-related pain and MSD-pain comorbidities among Veterans of OEF/OIF/OND wars. The specific aims are to: (1) to determine the extent of CAM use; (2) determine the cost of that CAM use; (3) determine the cost effectiveness of adjunctive CAM use compared to usual care alone as well as the healthcare cost impact of CAM use with both pain and pain-comorbid conditions; and (4) obtain feedback on CAM use, CAM costs and study results to better facilitate the integration of those results into recommendations for VA delivery f CAM, using an advisory board of key VA stakeholders. Methods: This study will capitalize on the existing VA MSD Cohort dataset, a comprehensive set of data on health care use and costs and patient and facility characteristics, and on the recent uploading of individual CAM notes to the VA's centralized data analysis platform (VINCI). We will use natural language processing (NLP) data mining methods to extract CAM use data from narrative medical record notes, focusing on the top ten CAM modalities used for MSD pain according to the VA's Healthcare Analysis & Information Group (HAIG) report. We will the VA MSD pain population using the set of pre-designated ICD-9 codes used in the VA MSD Cohort data. We will compare those who used CAM to matched controls who did not use CAM for their MSD pain using doubly robust estimation methods. We also will examine the impact of the amount of ten different types of CAM. Additionally, we will examine the impact of CAM use on pain comorbidities such as traumatic brain injury (TBI) and mental health conditions (PTSD, substance abuse disorder, sleep disturbance, anxiety, and depression). To address any large variation in results and to enable confidence in the answers generated, we will perform sensitivity analyses. The advisory board will contain the VA's national leaders in pain treatment and policy and CAM policy and delivery. Significance: Chronic MSD pain and its co- morbidities are costly to treat and highly prevalent among OEF/OIF/OND Veterans. CAM appears to be in widespread use for pain management at the VA. However, little is known about what types of CAM are used, the costs of providing CAM, and whether this CAM use results in reductions in healthcare costs (including opioid use) among those with MSD pain and those with MSD pain and its mental health comorbidities and TBI. The results of this cost-effectiveness study will help the VA determine if CAM, and what particular types of CAM, is an efficient way to reduce MSD pain and its co-morbid conditions given limited resources. The results will also be useful to other large healthcare organizations in terms of providing information on the costs and impacts of one model of how CAM services could be delivered. Innovation: This will be the first widespread study of the overall impact of CAM use on healthcare utilization and health care cost at the VA. This also will be the first multi-site examination of individual-level CAM use among Veterans with MSD pain.

描述（由申请人提供）：拟议研究的目标是检查补充和替代医学 (CAM) 在减少 OEF/OIF/OND 战争退伍军人中肌肉骨骼 (MSD) 相关疼痛和 MSD 疼痛合并症方面的成本效益。具体目标是： (1) 确定 CAM 使用的范围； (2) 确定 CAM 使用的成本； (3) 确定与单独常规护理相比辅助 CAM 使用的成本效益，以及使用 CAM 对疼痛和疼痛共存疾病的医疗成本影响； (4) 利用主要 VA 利益相关者组成的咨询委员会，获取有关 CAM 使用、CAM 成本和研究结果的反馈，以更好地促进将这些结果纳入 CAM 中 VA 交付的建议。方法：本研究将利用现有的 VA MSD 队列数据集，这是一组有关医疗保健使用和成本以及患者和设施特征的综合数据，以及最近上传到 VA 集中数据分析平台 (VINCI) 的个人 CAM 注释。我们将使用自然语言处理 (NLP) 数据挖掘方法从叙述性病历记录中提取 CAM 使用数据，重点关注根据 VA 医疗分析与信息小组 (HAIG) 报告用于治疗 MSD 疼痛的十大 CAM 模式。我们将使用 VA MSD 队列数据中使用的一组预先指定的 ICD-9 代码来确定 VA MSD 疼痛人群。我们将使用双稳健估计方法，将使用 CAM 的患者与未使用 CAM 治疗 MSD 疼痛的对照对照进行比较。我们还将研究十种不同类型 CAM 数量的影响。此外，我们还将研究 CAM 的使用对创伤性脑损伤 (TBI) 等疼痛合并症和心理健康状况（创伤后应激障碍 (PTSD)、药物滥用障碍、睡眠障碍、焦虑和抑郁）的影响。为了解决结果中的任何较大差异并确保生成的答案的可信度，我们将进行敏感性分析。该顾问委员会将包括 VA 疼痛治疗和政策以及 CAM 政策和实施方面的国家领导人。意义：慢性 MSD 疼痛及其合并症的治疗费用昂贵，并且在 OEF/OIF/OND 退伍军人中非常普遍。 CAM 似乎在 VA 广泛用于疼痛管理。然而，人们对使用哪些类型的 CAM、提供 CAM 的成本以及这种 CAM 的使用是否会降低 MSD 疼痛患者以及 MSD 疼痛及其心理健康合并症患者的医疗费用（包括阿片类药物使用）知之甚少。和创伤性脑损伤。这项成本效益研究的结果将帮助 VA 确定 CAM 以及哪些特定类型的 CAM 是否是在资源有限的情况下减少 MSD 疼痛及其并发症的有效方法。研究结果对于其他大型医疗保健组织也很有用，因为它提供了有关如何提供 CAM 服务的一种模型的成本和影响的信息。创新：这将是第一个关于 CAM 使用对 VA 医疗保健利用和医疗保健成本总体影响的广泛研究。这也将是对患有 MSD 疼痛的退伍军人进行个人层面 CAM 使用情况的首次多地点检查。

项目成果

The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US Veterans: An economic evaluation.

使用补充和综合健康方法治疗年轻美国退伍军人的慢性肌肉骨骼疼痛：经济评估。

• 发表时间: 2019
• 影响因子: 3.7
• 作者: Herman, Patricia M;Yuan, Anita H;Cefalu, Matthew S;Chu, Karen;Zeng, Qing;Marshall, Nell;Lorenz, Karl A;Taylor, Stephanie L
• 通讯作者: Taylor, Stephanie L