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Harwood K1, Frogner B2, Andrilla H2, Pines J3
1George Washington University, Clinical Research and Leadership, Washington, United States, 2University of Washington, Family Medicine, Seatle, United States, 3George Washington University, Center for Healthcare Innovation and Policy Research, Washington, United States
Background: Low back pain (LBP) is the most common type of pain experienced in the United States (US). Currently, half of patients with LBP receive opioid prescriptions, and despite clinical practice guidelines, physical, exercise and psychological therapies are used less frequently, 12%, 19% and 8%, respectively. Recent evidence suggests that the opioid crisis may be effecting the global community. In a preliminary investigation, we studied 148,866 private health insurance claims for patients with LBP in six western states and found that persons with LBP who were seen by physical therapists (PT) first had an 89.4% lower probability of receiving an opioid prescription, 27.9% lower probability of having any advanced imaging services and 14.7% lower probability of Emergency Department visits (all at p 0.001). These patients also had lower outpatient, pharmacy and out-of-pocket costs. This present study seeks to build off the preliminary findings by using a national US sample of LBP private insurance claims to investigate how the timing of PT care affects healthcare costs, utilization and short- and long-term opioid use.
Purpose: .The purposes of the study are to determine the effects of timing of PT on
1) healthcare cost and utilization; and
2) short- and long-term opioid use.
Methods: We will use private health insurance claims data from 2011-2016 provided by the Health Care Cost Institute (HCCI). HCCI data covers over 50 million individuals across the US, and includes patients covered by four insurance companies: Humana, UnitedHealth Group, Blue Cross/Blue Shield, and Kaiser Permanente. We will focus on a sample of patients age 18 to 64 years old residing in all 50 states and the District of Columbia. The healthcare utilization measures will include medical services (provider office visits, hospitalizations and Emergency Department visits), imaging (CT scan, MRI, and radiography imaging) and prescription drugs. Healthcare costs will include total costs, costs by setting (e.g. outpatient, inpatient), and total out-of-pocket costs for the patient. Short and long term opioid use will be defined using Centers for Disease Controls and Prevention (CDC) guidelines.
Healthcare costs and utilization, and short and long term opioid use, will be compared among three groups, those individuals who receive PT first, those who have PT intervention within the episode of LBP, and those that never see a PT. Each claim will be followed for 12 months after first visit. We will use a two-stage residual inclusion instrumental variables approach to reduce selection bias in initial choice of provider, probit analysis for utilization variables, and geographically weighted generalized linear (GLM) models assuming gamma distribution to estimate cost variables.
Results: The study is currently in progress. We expect to present preliminary data at the Congress.
Conclusion(s): The conclusions will be presented once the study is completed.
Implications: Implications: Although a recognized crises in the US, the inappropriate use of opioids has been growing internationally. The study will inform the international community on the important role of PT on health care costs, utilization and opioid use.
Keywords: opioid use, patient access, low back pain
Funding acknowledgements: This project was funded by the Foundation for Physical Therapy's' Health Services Research Pipeline Grant.
Purpose: .The purposes of the study are to determine the effects of timing of PT on
1) healthcare cost and utilization; and
2) short- and long-term opioid use.
Methods: We will use private health insurance claims data from 2011-2016 provided by the Health Care Cost Institute (HCCI). HCCI data covers over 50 million individuals across the US, and includes patients covered by four insurance companies: Humana, UnitedHealth Group, Blue Cross/Blue Shield, and Kaiser Permanente. We will focus on a sample of patients age 18 to 64 years old residing in all 50 states and the District of Columbia. The healthcare utilization measures will include medical services (provider office visits, hospitalizations and Emergency Department visits), imaging (CT scan, MRI, and radiography imaging) and prescription drugs. Healthcare costs will include total costs, costs by setting (e.g. outpatient, inpatient), and total out-of-pocket costs for the patient. Short and long term opioid use will be defined using Centers for Disease Controls and Prevention (CDC) guidelines.
Healthcare costs and utilization, and short and long term opioid use, will be compared among three groups, those individuals who receive PT first, those who have PT intervention within the episode of LBP, and those that never see a PT. Each claim will be followed for 12 months after first visit. We will use a two-stage residual inclusion instrumental variables approach to reduce selection bias in initial choice of provider, probit analysis for utilization variables, and geographically weighted generalized linear (GLM) models assuming gamma distribution to estimate cost variables.
Results: The study is currently in progress. We expect to present preliminary data at the Congress.
Conclusion(s): The conclusions will be presented once the study is completed.
Implications: Implications: Although a recognized crises in the US, the inappropriate use of opioids has been growing internationally. The study will inform the international community on the important role of PT on health care costs, utilization and opioid use.
Keywords: opioid use, patient access, low back pain
Funding acknowledgements: This project was funded by the Foundation for Physical Therapy's' Health Services Research Pipeline Grant.
Topic: Professional issues; Musculoskeletal: spine; Professional issues
Ethics approval required: Yes
Institution: George Washington University
Ethics committee: Institutional Review Board
Ethics number: 11814
All authors, affiliations and abstracts have been published as submitted.
