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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
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Details:
  • Funding:
    1 R0 OH04069/OH/NIOSH CDC HHS/United States
    1 T42 OH008433/OH/NIOSH CDC HHS/United States
    R01 HS019222-01/HS/AHRQ HHS/United States
    T32 HD057822/HD/NICHD NIH HHS/United States
    T32 HD057822-01A2/HD/NICHD NIH HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Objective

    To estimate health care utilization and costs associated with adherence to clinical practice guidelines for the use of early 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%) were classified as non-adherent to guidelines. Outpatient and physical/occupational therapy utilization was 52–54% 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%).

    Conclusions

    Non-adherence to guidelines for early MRI was associated with increased likelihood of lumbosacral injections or surgery and higher costs for outpatient, inpatient, and non-medical services, and disability compensation.