Dataset Information

Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.

ABSTRACT: Compare health care utilization and charges for low-back-pain (LBP) patients receiving advanced imaging or physical therapy as a first management strategy following a new primary care consultation.Electronic medical record (EMR) and insurance claims data.Retrospective analysis of propensity-matched groups.Claims and EMR data were used. Utilization and LBP-related charges over a 1-year period were extracted from claims data.In the propensity-matched sample (n = 406), advanced imaging recipients had higher odds of all utilization outcomes. Charges were higher with advanced imaging by an average $4,793 (95 percent CI: $3,676, $5,910).For patients with LBP whom newly consulted primary care referred for additional management, advanced imaging as a first management was associated with higher health care utilization and charges than physical therapy.

SUBMITTER: Fritz JM

PROVIDER: S-EPMC4693839 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.

Fritz Julie M JM Brennan Gerard P GP Hunter Stephen J SJ

Health services research 20150316 6

<h4>Objective</h4>Compare health care utilization and charges for low-back-pain (LBP) patients receiving advanced imaging or physical therapy as a first management strategy following a new primary care consultation.<h4>Data source</h4>Electronic medical record (EMR) and insurance claims data.<h4>Study design</h4>Retrospective analysis of propensity-matched groups.<h4>Data collection/extraction</h4>Claims and EMR data were used. Utilization and LBP-related charges over a 1-year period were extrac ...[more]

PMID: 25772625

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Project description:STUDY DESIGN:Secondary analysis of the Back Pain Outcomes using Longitudinal Data (BOLD) cohort study. OBJECTIVE:To characterize associations of self-reported race/ethnicity with back pain (BP) patient-reported outcomes (PROs) and health care utilization among older adults with a new episode of care for BP. SUMMARY OF BACKGROUND DATA:No prior longitudinal studies have characterized associations between multiple race/ethnicity groups, and BP-related PROs and health care utilization in the United States. METHODS:This study included 5117 participants ?65 years from three US health care systems. The primary BP-related PROs were BP intensity and back-related functional limitations over 24 months. Health care utilization measures included common diagnostic tests and treatments related to BP (spine imaging, spine-related relative value units [RVUs], and total RVUs) over 24 months. Analyses were adjusted for multiple potential confounders including sociodemographics, clinical characteristics, and study site. RESULTS:Baseline BP ratings were significantly higher for blacks vs. whites (5.8 vs. 5.0; P?<?0.001). Participants in all race/ethnicity groups showed statistically significant, but modest improvements in BP over 24 months. Blacks and Hispanics did not have statistically significant improvement in BP-related functional limitations over time, unlike whites, Asians, and non-Hispanics; however, the magnitude of differences in improvement between groups was small. Blacks had less spine-related health care utilization over 24 months than whites (spine-related RVU ratio of means 0.66, 95% confidence interval [CI] 0.51-0.86). Hispanics had less spine-related health care utilization than non-Hispanics (spine-related RVU ratio of means 0.60; 95% CI 0.40-0.90). CONCLUSION:Blacks and Hispanics had slightly less improvement in BP-related functional limitations over time, and less spine-related health care utilization, as compared to whites and non-Hispanics, respectively. Residual confounding may explain some of the association between race/ethnicity and health outcomes. Further studies are needed to understand the factors underlying these differences and which differences reflect disparities. LEVEL OF EVIDENCE:3.

Project description:Aims and objectivesTo describe characteristics of service utilization by advanced practice nurses (APNs) employing an electronic consultation (eConsult) service in their care for older adults.BackgroundCanada's aging population is projected to place unprecedented demands on the healthcare system. APNs, which include clinical nurse specialists (CNSs) and nurse practitioners (NPs), are nurses with advanced knowledge who can independently provide age-appropriate care. eConsult is a secure web-based platform enabling asynchronous, provider-to-provider communication. APNs can send and receive eConsults to address patient-specific concerns.MethodsThis is a retrospective analysis of eConsult utilization and user survey data for cases completed in 2019, reported in line with the STROBE guidelines. Eligible eConsults included those that had APN involvement (as a referrer or responder) and were concerning an older patient (≥65 years). Descriptive statistics were used to analyse service utilization and survey response data.ResultsOf 430 eligible eConsults, 421 (97.9%) were initiated by NPs and the rest by physicians. 23 (5.3%) were received by a CNS, of which 14 (3.3%) involved an NP-to-CNS exchange. Median specialist response interval was 0.9 days. 53% of eConsults was for dermatology, haematology, cardiology, gastroenterology and endocrinology. 73% of eConsults avoided a face-to-face referral after the consultation. In 90% of eConsults, APNs rated the service as helpful and/or educational.ConclusionsThrough eConsult, APNs can collaborate with each other and physicians to access and provide a breadth of advice facilitating timely specialist-informed care for older patients, thus helping to alleviate some of the demands placed on the healthcare system.Relevance to clinical practiceThere is an opportunity for APNs to further adopt eConsult into their clinical practice, and this can, in turn, support the integration of the APN role in the health workforce.Patient or public contributionCurrent APN eConsult users were involved in the study design and interpretation of results.

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Project description:Nearly 2 million patients visit emergency departments (EDs) because of eye concerns annually in the United States. How hospitals currently assign these patients to treatment is important for designing systems that equitably allocate resources for eye care in urgent settings.To investigate factors associated with ophthalmology consultation for eye-related adult ED encounters to assess possible disparities by sex, race/ethnicity, language preference, or residential distance from the medical center.Retrospective observational study of 13 361 adult ED encounters associated with an eye-related billing diagnosis between January 1, 2010, and September 30, 2015, at the University of Michigan Medical Center in Ann Arbor.Measures available from the University of Michigan clinical data warehouse included age, sex, race/ethnicity, preferred language, home distance from the ED, calendar year of encounter, and Charlson-Deyo Comorbidity Index score.Association of the ED encounter with ophthalmology consultation. An ophthalmology consultation was identified by cross-referencing ophthalmology faculty and clinical instructors from 2010 to 2015 against billing providers for consultations using the Charlson-Deyo Comorbidity Index score and billing codes. Measures included patient age, sex, race/ethnicity, home address, preferred language (English vs non-English), and calendar year of encounter.Among the 13 361 encounters, 6840 (51.2%) involved a female patient. Mean (SD) age at encounter was 50.7 (19.3) years; 10 033 patients (75.1%) were of white and 1969 (14.7%) of black race/ethnicity. English was the preferred language for 13 022 patients (97.5%). The ophthalmology service was consulted in 5289 encounters (39.6%). Black patients had significantly lower odds of an ophthalmology consultation than white patients (odds ratio [OR], 0.85; 95% CI, 0.75-0.96). Patients who preferred a non-English language had significantly lower odds of receiving an ophthalmology consultation (OR, 0.73; 95% CI, 0.55-0.98).Many of the 13 361 eye-related ED encounters were managed by ED clinicians with no ophthalmology consultation. Patients who were black or who preferred a language other than English were less likely to have an ophthalmologist involved in their care. The associations found in this observational study do not imply causation but suggest disparities in care that should be further investigated.

Dataset Information

Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.

Publications

Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.

Similar Datasets

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