Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain

Details

• Personal Author:
  Franklin GM ; Fulton-Kehoe D ; Graves JM ; Jarvik JG ; Franklin GM ; Fulton-Kehoe D ; Graves JM ; Jarvik JG
• Description:
  OBJECTIVE: To estimate health care utilization and costs associated with adherence to clinical practice guidelines for the use of early magnetic resonance imaging (MRI; within the first 6 weeks of injury) for acute occupational low back pain (LBP). DATA SOURCES: Washington State Disability Risk Identification Study Cohort (D-RISC), consisting of administrative claims and patient interview data from workers' compensation claimants (2002-2004). STUDY DESIGN: In this prospective, population-based cohort study, we compared health care utilization and costs among workers whose imaging was adherent to guidelines (no early MRI) to workers whose imaging was not adherent to guidelines (early MRI in the absence of red flags). DATA COLLECTION/EXTRACTION METHODS: We identified workers (age >18) with work-related LBP using administrative claims. We obtained demographic, injury, health, and employment information through telephone interviews to adjust for baseline differences between groups. We ascertained health care utilization and costs from administrative claims for 1 year following injury. PRINCIPAL FINDINGS: Of 1,770 workers, 336 (19.0 percent) were classified as nonadherent to guidelines. Outpatient and physical/occupational therapy utilization was 52-54 percent higher for workers whose imaging was not adherent to guidelines compared to workers with guideline-adherent imaging; utilization of chiropractic care was significantly lower (18 percent). CONCLUSIONS: Nonadherence to guidelines for early MRI was associated with increased likelihood of lumbosacral injections or surgery and higher costs for out-patient, inpatient, and nonmedical services, and disability compensation. [Description provided by NIOSH]
• Subjects:
  Diagnosis Health Care Facilities Workforce And Services Musculoskeletal Diseases Musculoskeletal System Occupational Health Safety Surveys And Questionnaires
• Keywords:
  Author Keywords: Low Back Pain Back-injuries Clinical-diagnosis Clinical Practice Guidelines Costs Diagnostic-techniques Diagnostic Imaging Disabled-workers Health-care Health-standards Health-surveys Information-retrieval-systems Injuries Medical-equipment Medical-services Musculoskeletal-system-disorders Outpatient-facilities Physical-therapy Utilization Work-practices Workers' Compensation

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• ISSN:
  0017-9124
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article ; Journal Article
• Place as Subject:
  OSHA Region 10 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH) ; National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health ; Workplace Safety & Health
• Location:
  North America ; North America
• Volume:
  49
• Issue:
  2
• NIOSHTIC Number:
  nn:20043091
• Citation:
  Health Serv Res 2014 Apr; 49(2):645-665
• Contact Point Address:
  Janessa M. Graves, MPH, PhD, Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Avenue, Seattle, WA 98104-2499
• Email:
  janessa@uw.edu
• Federal Fiscal Year:
  2014
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20010930
• Source Full Name:
  Health Services Research
• End Date:
  20070929
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:5a5a35791eeefefa76c342bedbeeaadb878eeb03adb4db85627faf5815fa7c899321a265c937b2092e693d7042dbc5fb529165eecddf68cc560f55c86cf1eca1
• Download URL:
  https://stacks.cdc.gov/view/cdc/195105/cdc_195105_DS1.pdf
• File Type:
  [PDF - 167.48 KB ]