The cost impact of a quality-assured mechanical assessment in primary low back pain care
| Autor: | Kevin F. Spratt, Ronald Donelson, Eric Gatmaitan, J Mark Miller, W Steve McClellan, Richard Gray |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty media_common.quotation_subject Occupational Health Services Physical Therapy Sports Therapy and Rehabilitation Physical examination Cohort Studies 03 medical and health sciences 0302 clinical medicine Lumbar Cost Savings medicine Humans Quality (business) Orthopedic Procedures Community Health Services Longitudinal Studies Average cost Injections Spinal media_common 030222 orthopedics medicine.diagnostic_test Primary Health Care business.industry Risk adjustment Middle Aged Low back pain Magnetic Resonance Imaging United States Original Research Paper Relative risk Physical therapy Female Diagnosis code medicine.symptom business Low Back Pain 030217 neurology & neurosurgery |
| Zdroj: | J Man Manip Ther |
| ISSN: | 2042-6186 |
| Popis: | Objectives: The escalating cost of low back pain (LBP) care has not improved outcomes. Our purpose: to compare costs between LBP care guided by a quality-assured mechanical assessment (MC) and usual community care (CC). Study Design: Administrative claims data analysis. Methods: Employees and dependents of a large self-insured manufacturer seeking care for LBP in 2013 chose between the company’s primary care clinic (where MC was delivered) and community care. The claims of 5,036 were analyzed for one year following subjects’ initial evaluation excluding only those with diagnostic codes for fractures, dislocations, or infections. MC included an advanced form of Mechanical Diagnosis & Therapy (MDT). CC varied based on each subjects’ selection of providers. Primary outcome measure: one-year cost of each subject’s care. Secondary: number of MRIs, spinal injections, and lumbar surgeries undertaken. The payer’s proprietary risk-adjustment algorithm was utilized. Results: After risk adjustment, the average cost per MC subject was 51.48% lower than the CC average cost (p < .0279). The utilization of MRIs, injections, and surgeries was lower with MC by 49.75%, 39.44%, 78.38% with relative risks of 1.99, 1.64, and 4.73, respectively. Conclusions: This 51.5% cost-savings reflects the substantial reduction in downstream care-seeking with MC, including lower utilization of MRIs, injections, surgeries, and downstream care after six months from the initial visit. It is well documented that the MDT clinical examination typically elicit patterns of pain response that in turn identify how most can rapidly recover with self-care with no need for other intervention. Level of Evidence: 1b. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|