scholarly journals The Effect of Back Pain on Health Care Utilization and Costs

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Jessica J Wong ◽  
Pierre Côté ◽  
Andrea C Tricco ◽  
Tristan Watson ◽  
Laura C Rosella
Keyword(s):  
Health Care ◽  
Back Pain ◽  
Propensity Score ◽  
Health Care Utilization ◽  
Canadian Community Health Survey ◽  
Population Based ◽  
Care Utilization ◽  
Physician Visits ◽  
Health Related ◽  
Behavioural Factors

Introduction: We assessed the effect of self-reported back pain on health care utilization and costs in a population-based sample of Ontario adults. Methods: We conducted a population-based matched cohort study of Ontarian respondents aged ≥18 years of Canadian Community Health Survey (CCHS) from 2003-2012. CCHS data were individually linked to health administrative data to measure health care utilization and costs up to 2018. We propensity-score matched (hard-matched on sex) adults with self-reported back pain to those without back pain, accounting for sociodemographic, health-related, and behavioural factors. We evaluated back pain-specific and all-cause health care utilization and costs from healthcare payer perspective adjusted to 2018 Canadian dollars. Poisson and linear (log-transformed) models were used to assess healthcare utilization rates and costs.  Results: After propensity-score matching, we identified 36,806 pairs (21,054 for women, 15,752 for men) of CCHS respondents with and without back pain (mean age 51 years; SD=18). Compared to propensity-score matched adults without back pain, adults with back pain had two times the rate of back pain-specific visits (women: rate ratio [RR] 2.06, 95% CI 1.88-2.25; men: RR 2.32, 95% CI 2.04-2.64), 1.1 times the rate of all-cause physician visits (women: RR 1.12, 95% CI 1.09-1.16; men: RR 1.10, 95% CI 1.05-1.14), and 1.2 times the costs (women: 1.21, 95% CI 1.16-1.27; men: 1.16, 95% CI 1.09-1.23). Incremental annual per-person costs were higher in adults with back pain versus those without (women: $395, 95% CI $281-$509; men: $196, 95% CI $94-$300), corresponding to $532 million for women and $227 million CAD for men annually in Ontario. Conclusions: Adults with back pain had considerably higher health care utilization and costs compared to adults without back pain. These findings provide the most recent, comprehensive, and high-quality estimates of the health system burden of back pain to inform healthcare policy and decision-making. New strategies to reduce the substantial burden of back pain are warranted.

Infection-related health care utilization among people with and without multiple sclerosis

2016 ◽  
Vol 23 (11) ◽  
pp. 1506-1516 ◽  
Author(s):  
José MA Wijnands ◽  
Elaine Kingwell ◽  
Feng Zhu ◽  
Yinshan Zhao ◽  
John D Fisk ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Care Utilization ◽  
Age Groups ◽  
Population Based ◽  
Care Utilization ◽  
Prescription Data ◽  
Physician Visits ◽  
Intestinal Infections ◽  
Adjusted Rate

Background: Little is known about infection risk in multiple sclerosis (MS). Objective: We examined infection-related health care utilization in people with and without MS. Methods: Using population-based health administrative data from British Columbia, Canada, people with MS were followed from their first demyelinating claim (1996–2013) until death, emigration, or study end (2013). Infection-related hospital, physician, and prescription data of MS cases were compared with sex-, age-, and geographically matched controls using adjusted regression models. Sex and age differences (18–39, 40–49, 50–59, 60+ years) were explored. Results: Relative to 35,837 controls, 7179 MS cases were over twice as likely to be hospitalized for infection (adjusted odds ratio: 2.39; 95% confidence interval (CI): 2.16–2.65), had 41% more physician visits (adjusted rate ratio (aRR): 1.41; 95% CI: 1.36–1.47), and filled 57% more infection-related prescriptions (aRR: 1.57; 95% CI: 1.49–1.65). Utilization was disproportionately higher in MS men than women and was elevated across all ages. MS cases had nearly twice as many physician visits and two to three times more hospitalizations for pneumonia, urinary system infections, and skin infections (aRRs ranged from 1.6 to 3.3) and over twice as many hospitalizations for intestinal infections (aRR = 2.6) and sepsis (aRR = 2.2). Conclusion: Infection-related health care utilization was increased in people with MS across all age groups, with a higher burden for men.

scholarly journals Emergency department revisits and rehospitalizations among infants and toddlers for acute allergic reactions

2021 ◽  
Vol 42 (3) ◽  
pp. 247-256
Author(s):  
Lacey B. Robinson ◽  
Anna Chen Arroyo ◽  
Rebecca E. Cash ◽  
Susan A. Rudders ◽  
Carlos A. Camargo
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
New York ◽  
Health Care Utilization ◽  
Population Based ◽  
Care Utilization ◽  
Allergic Reactions ◽  
Infants And Toddlers ◽  
Ed Visits ◽  
Total Charges

Background and Objective: Allergic reactions, including anaphylaxis, are rising among children. Little is known about health care utilization among infants and toddlers. Our objective was to characterize health care utilization and charges for acute allergic reactions (AAR). Methods: We conducted a retrospective cohort study of trends in emergency department (ED) visits and revisits, hospitalizations and rehospitalizations, and charges among infants and toddlers (ages < 3 years), with an index ED visit or hospitalization for AAR (including anaphylaxis). We used data from population-based multipayer data: State Emergency Department Databases and State Inpatient Databases from New York and Nebraska. Multivariable logistic regression was used to identify factors associated with ED revisits and rehospitalizations. Results: Between 2006 and 2015, infant and toddler ED visits for AAR increased from 27.8 per 10,000 population to 35.2 (Ptrend < 0.001), whereas hospitalizations for AAR remained stable (Ptrend = 0.11). In the one year after an index AAR visit, 5.1% of these patients had at least one AAR ED revisit and 5.9% had at least one AAR rehospitalization. Factors most strongly associated with AAR ED revisits included an index visit hospitalization and receipt of epinephrine. Total charges for AAR ED visits (2009‐2015) and hospitalizations (2011‐2015) were more than $29 million and $11 million, respectively. Total charges increased more than fourfold for both AAR ED revisits for AAR rehospitalizations during the study period. Conclusion: Infants and toddlers who presented with an AAR were at risk for ED revisits and rehospitalizations for AAR within the following year. The charges associated with these revisits were substantial and seemed to be increasing.

scholarly journals Where to Start? A Two Stage Residual Inclusion Approach to Estimating Influence of the Initial Provider on Health Care Utilization and Costs for Low Back Pain in the US

2021 ◽  
Author(s):  
Kenneth Harwood ◽  
Jesse Pines ◽  
C. Holly A. Andrilla ◽  
Bianca K. Frogner
Keyword(s):  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Health Care Utilization ◽  
Index Date ◽  
Care Utilization ◽  
Low Back ◽  
Opioid Prescription ◽  
Serious Illness

Abstract Background: Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs. Methods: Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions, or an opioid prescription recorded in the six months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a common econometric technique, two-stage residual inclusion (2SRI) estimation to reduce selection bias in the choice of first provider, controlling for demographics.Results: Among 3,799,593 individuals, cost and utilization varied considerably based on first provider seen by the patient. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5,093) or primary care physician ($5,660), and highest when starting with an orthopedist ($9,434) or acupuncturist ($9,205). Conclusion: The first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness.

Half-Managed Care

2015 ◽  
Vol 47 (3) ◽  
pp. 519-531
Author(s):  
Shou-Hsia Cheng ◽  
Chih-Ming Chang ◽  
Chi-Chen Chen ◽  
Chih-Yuan Shih ◽  
Shu-Ling Tsai
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Estimating Equation ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
The Novel ◽  
Minimal Impact ◽  
Physician Visits ◽  
Comparison Groups ◽  
Patient Model

In 2011, a novel capitation program was launched in Taiwan under its universal health insurance plan. This study aimed to assess the short-term impact of the program. Two hospitals in the greater Taipei area, one participating in the “loyal patient” model (13,319 enrollees) and one in the “regional resident” model (13,768 enrollees), were analyzed. Two comparison groups were selected by propensity score matching. Generalized estimating equation models with differences-in-differences analysis were used to examine the net effects of the capitation program on health care utilization, expenses, and outcomes. Enrollees in the loyal patient model had fewer physician visits in the host hospital, but more physician visits outside that hospital during the program year than they had the year before. Compared with non-enrollees, the loyal patient model enrollees incurred fewer physician visits (β = −0.042, p < .001), fewer emergency department visits, (β = −0.140, p < .001), and similar total expenses and outcome. For the regional resident model, no differences were found in the number of physician visits, expenses, or outcomes between enrollees and non-enrollees. The novel capitation models in Taiwan had minimal impact on health care utilization after 1 year of implementation and the health care outcome was not compromised.

Associations of androgens with health care utilization and costs in women—Perspectives of a population-based cohort study

Maturitas ◽  
2016 ◽  
Vol 89 ◽  
pp. 5-8
Author(s):  
Robin Haring ◽  
Henri Wallaschofski ◽  
Henry Völzke ◽  
Steffen Flessa ◽  
Brian G. Keevil ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Health Care Utilization ◽  
Population Based ◽  
Care Utilization
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