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Factors associated with persistently high-cost health care utilization for musculoskeletal pain


Autoři: Trevor A. Lentz aff001;  Jeffrey S. Harman aff002;  Nicole M. Marlow aff003;  Jason M. Beneciuk aff004;  Roger B. Fillingim aff005;  Steven Z. George aff001
Působiště autorů: Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America aff001;  Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, Florida, United States of America aff002;  Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida, United States of America aff003;  Brooks Rehabilitation – College of Public Health & Health Professions Research Collaboration, Department of Physical Therapy, University of Florida, Gainesville, Florida, United States of America aff004;  Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225125

Souhrn

Background

Musculoskeletal pain conditions incur high costs and produce significant personal and public health consequences, including disability and opioid-related mortality. Persistence of high-cost health care utilization for musculoskeletal pain may help identify system inefficiencies that could limit value of care. The objective of this study was to identify factors associated with persistent high-cost utilization among individuals seeking health care for musculoskeletal pain.

Methods

This was a retrospective cohort study of Medical Expenditure Panel Survey data (2008–2013) that included a non-institutionalized, population-based sample of individuals seeking health care for a musculoskeletal pain condition (n = 12,985). Expenditures associated with musculoskeletal pain conditions over two consecutive years were analyzed from prescribed medicine, office-based medical provider visits, outpatient department visits, emergency room visits, inpatient hospital stays, and home health visits. Persistent high-cost utilization was defined as being in the top 15th percentile for annual musculoskeletal pain-related expenditures over 2 consecutive years. We used multinomial regression to determine which modifiable and non-modifiable sociodemographic, health, and pain-related variables were associated with persistent high-cost utilization.

Results

Approximately 35% of direct costs for musculoskeletal pain were concentrated among the 4% defined as persistent high-cost utilizers. Non-modifiable variables associated with expenditure group classification included age, race, poverty level, geographic region, insurance status, diagnosis type and total number of musculoskeletal pain diagnoses. Modifiable variables associated with increased risk of high expenditure classification were higher number of missed work days, greater pain interference, and higher use of prescription medication for pain, while higher self-reported physical and mental health were associated with lower risk of high expenditure classification.

Conclusions

Health care delivery models that prospectively identify these potentially modifiable factors may improve the costs and value of care for individuals with musculoskeletal pain prone to risk for high-cost care episodes.

Klíčová slova:

Health economics – Mental health and psychiatry – Health care policy – Pain management – Depression – Insurance – Myalgia – Pain psychology


Zdroje

1. Mitchell EM. Concentration of Health Expenditures in the U.S. Civilian Noninstitutionalized Population, 2014. Statistical Brief (Medical Expenditure Panel Survey (US)). Rockville (MD): Agency for Healthcare Research and Quality (US); 2001. http://www.ncbi.nlm.nih.gov/books/NBK425792/

2. Emeche U. Is a Strategy Focused on Super-Utilizers Equal to the Task of Health Care System Transformation? Yes. Ann Fam Med. 2015;13: 6–7. doi: 10.1370/afm.1746 25583884

3. Von Korff M, Scher AI, Helmick C, Carter-Pokras O, Dodick DW, Goulet J, et al. United States National Pain Strategy for Population Research: Concepts, Definitions, and Pilot Data. J Pain Off J Am Pain Soc. 2016;17: 1068–1080. doi: 10.1016/j.jpain.2016.06.009 27377620

4. Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain Off J Am Pain Soc. 2012;13: 715–724. doi: 10.1016/j.jpain.2012.03.009 22607834

5. Traeger AC, Henschke N, Hübscher M, Williams CM, Kamper SJ, Maher CG, et al. Estimating the Risk of Chronic Pain: Development and Validation of a Prognostic Model (PICKUP) for Patients with Acute Low Back Pain. PLoS Med. 2016;13: e1002019. doi: 10.1371/journal.pmed.1002019 27187782

6. Rosella LC, Fitzpatrick T, Wodchis WP, Calzavara A, Manson H, Goel V. High-cost health care users in Ontario, Canada: demographic, socio-economic, and health status characteristics. BMC Health Serv Res. 2014;14: 532. doi: 10.1186/s12913-014-0532-2 25359294

7. Chechulin Y, Nazerian A, Rais S, Malikov K. Predicting patients with high risk of becoming high-cost healthcare users in Ontario (Canada). Healthc Policy Polit Sante. 2014;9: 68–79.

8. Heslop L, Athan D, Gardner B, Diers D, Poh BC. An analysis of high-cost users at an Australian public health service organization. Health Serv Manage Res. 2005;18: 232–243. doi: 10.1258/095148405774518633 16259671

9. Andersen RM. Revisiting the Behavioral Model and Access to Medical Care: Does it Matter? J Health Soc Behav. 1995;36: 1–10. doi: 10.2307/2137284 7738325

10. Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260: 1743–1748. 3045356

11. Lentz TA, Harman JS, Marlow NM, George SZ. Application of a Value Model for the Prevention and Management of Chronic Musculoskeletal Pain by Physical Therapists. Phys Ther. 2017;97: 354–364. 28204786

12. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163: 2433–2445. doi: 10.1001/archinte.163.20.2433 14609780

13. Hart DL, Werneke MW, Deutscher D, George SZ, Stratford PW, Mioduski JE. Using intake and change in multiple psychosocial measures to predict functional status outcomes in people with lumbar spine syndromes: a preliminary analysis. Phys Ther. 2011;91: 1812–1825. doi: 10.2522/ptj.20100377 22003164

14. Ritzwoller DP, Crounse L, Shetterly S, Rublee D. The association of comorbidities, utilization and costs for patients identified with low back pain. BMC Musculoskelet Disord. 2006;7: 72. doi: 10.1186/1471-2474-7-72 16982001

15. Nyman JA. Is ‘Moral Hazard’ Inefficient? The Policy Implications Of A New Theory. Health Aff (Millwood). 2004;23: 194–199. doi: 10.1377/hlthaff.23.5.194 15371385

16. Gatchel RJ, Reuben DB, Dagenais S, Turk DC, Chou R, Hershey AD, et al. Research Agenda for the Prevention of Pain and Its Impact: Report of the Work Group on the Prevention of Acute and Chronic Pain of the Federal Pain Research Strategy. J Pain Off J Am Pain Soc. 2018;19: 837–851. doi: 10.1016/j.jpain.2018.02.015 29578089

17. Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, et al. Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health. The Gerontologist. 2016;56 Suppl 2: S243–255. doi: 10.1093/geront/gnw002 26994264

18. Cohen J. Sample Design of the Medical Expenditure Panel Survey Household Component. Rockville, MD: Agency for Healthcare Research and Quality; 1997.

19. Cohen S. Testing for Survey Attrition Effects on Estimates of Chronic Disease Costs in a National Longitudinal Medical Expenditure Survey. Rockville, MD: Agency for Healthcare Research and Quality; 2009.

20. BMUS: The Burden of Musculoskeletal Diseases in the United States. In: BMUS: The Burden of Musculoskeletal Diseases in the United States [Internet]. [cited 10 Jun 2019]. https://www.boneandjointburden.org/

21. Elliott MN, Beckett MK, Chong K, Hambarsoomians K, Hays RD. How do proxy responses and proxy-assisted responses differ from what Medicare beneficiaries might have reported about their health care? Health Serv Res. 2008;43: 833–848. doi: 10.1111/j.1475-6773.2007.00820.x 18454770

22. Roydhouse JK, Gutman R, Keating NL, Mor V, Wilson IB. Proxy and patient reports of health-related quality of life in a national cancer survey. Health Qual Life Outcomes. 2018;16: 6. doi: 10.1186/s12955-017-0823-5 29304818

23. Roydhouse JK, Gutman R, Keating NL, Mor V, Wilson IB. The Association of Proxy Care Engagement with Proxy Reports of Patient Experience and Quality of Life. Health Serv Res. 2018;53: 3809–3824. doi: 10.1111/1475-6773.12980 29806212

24. Coughlan D, Yeh ST, O’Neill C, Frick KD. Evaluating direct medical expenditures estimation methods of adults using the medical expenditure panel survey: an example focusing on head and neck cancer. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2014;17: 90–97. doi: 10.1016/j.jval.2013.10.004 24438722

25. Horner-Johnson W, Dobbertin K, Lee JC, Andresen EM, Expert Panel on Disability and Health Disparities. Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey. Health Serv Res. 2014;49: 1980–1999. doi: 10.1111/1475-6773.12195 24962662

26. Harris LJ, Graetz I, Podila PSB, Wan J, Waters TM, Bailey JE. Characteristics of Hospital and Emergency Care Super-utilizers with Multiple Chronic Conditions. J Emerg Med. 2016;50: e203–214. doi: 10.1016/j.jemermed.2015.09.002 26472609

27. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45: 613–619. doi: 10.1016/0895-4356(92)90133-8 1607900

28. Kelsall HL, McKenzie DP, Forbes AB, Roberts MH, Urquhart DM, Sim MR. Pain-related musculoskeletal disorders, psychological comorbidity, and the relationship with physical and mental well-being in Gulf War veterans. Pain. 2014;155: 685–692. doi: 10.1016/j.pain.2013.12.025 24361580

29. Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34: 220–233. doi: 10.1097/00005650-199603000-00003 8628042

30. Cross MJ, March LM, Lapsley HM, Byrne E, Brooks PM. Patient self-efficacy and health locus of control: relationships with health status and arthritis-related expenditure. Rheumatol Oxf Engl. 2006;45: 92–96. doi: 10.1093/rheumatology/kei114 16287930

31. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SLT, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32: 959–976. doi: 10.1017/s0033291702006074 12214795

32. Prochaska JJ, Sung H-Y, Max W, Shi Y, Ong M. Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. Int J Methods Psychiatr Res. 2012;21: 88–97. doi: 10.1002/mpr.1349 22351472

33. Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41: 1284–1292. doi: 10.1097/01.MLR.0000093487.78664.3C 14583691

34. Fujii T, Oka H, Katsuhira J, Tonosu J, Kasahara S, Tanaka S, et al. Association between somatic symptom burden and health-related quality of life in people with chronic low back pain. PLOS ONE. 2018;13: e0193208. doi: 10.1371/journal.pone.0193208 29462181

35. Karjalainen K, Malmivaara A, Mutanen P, Pohjolainen T, Roine R, Hurri H. Outcome Determinants of Subacute Low Back Pain. Spine. 2003;28: 2634–2640. doi: 10.1097/01.BRS.0000099097.61495.2E 14652481

36. Thomas E, Peat G, Harris L, Wilkie R, Croft PR. The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain. 2004;110: 361–368. doi: 10.1016/j.pain.2004.04.017 15275787

37. Cahana A, Dansie EJ, Theodore BR, Wilson HD, Turk DC. Redesigning delivery of opioids to optimize pain management, improve outcomes, and contain costs. Pain Med Malden Mass. 2013;14: 36–42. doi: 10.1111/pme.12013 23279325

38. Sennehed CP, Holmberg S, Axén I, Stigmar K, Forsbrand M, Petersson IF, et al. Early workplace dialogue in physiotherapy practice improved work ability at 1-year follow-up-WorkUp, a randomised controlled trial in primary care. Pain. 2018;159: 1456–1464. doi: 10.1097/j.pain.0000000000001216 29554017

39. Cullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA, et al. Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners. J Occup Rehabil. 2018;28: 1–15. doi: 10.1007/s10926-016-9690-x 28224415

40. Garfinkel SA, Riley GF, Iannacchione VG. High-cost users of medical care. Health Care Financ Rev. 1988;9: 41–52. 10312631

41. Leininger LJ, Saloner B, Wherry LR. Predicting high-cost pediatric patients: derivation and validation of a population-based model. Med Care. 2015;53: 729–735. doi: 10.1097/MLR.0000000000000391 26172939

42. de Oliveira C, Cheng J, Vigod S, Rehm J, Kurdyak P. Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients. Health Aff Proj Hope. 2016;35: 36–43. doi: 10.1377/hlthaff.2015.0278 26733699

43. How BLS Measures Price Change for Medical Care Services in the Consumer Price Index : U.S. Bureau of Labor Statistics. [cited 10 Jun 2019]. https://www.bls.gov/cpi/factsheets/medical-care.htm

44. Freud RJ, Littell RC. SAS System for Regression: Third Edition. SAS Institute; 2000.

45. Guilcher SJT, Bronskill SE, Guan J, Wodchis WP. Who Are the High-Cost Users? A Method for Person-Centred Attribution of Health Care Spending. PloS One. 2016;11: e0149179. doi: 10.1371/journal.pone.0149179 26937955

46. Maeng DD, Stewart WF, Yan X, Boscarino JA, Mardekian J, Harnett J, et al. Use of electronic health records for early detection of high-cost, low back pain patients. Pain Res Manag J Can Pain Soc. 2015;20: 234–240.

47. Medical Expenditure Panel Survey Computing Standard Errors for MEPS Estimates. [cited 10 Jun 2019]. https://meps.ahrq.gov/survey_comp/standard_errors.jsp

48. Franche R-L, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J, et al. Workplace-based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil. 2005;15: 607–631. doi: 10.1007/s10926-005-8038-8 16254759

49. Gurung T, Ellard DR, Mistry D, Patel S, Underwood M. Identifying potential moderators for response to treatment in low back pain: A systematic review. Physiotherapy. 2015;101: 243–251. doi: 10.1016/j.physio.2015.01.006 25769189

50. Thorn BE, Eyer JC, Van Dyke BP, Torres CA, Burns JW, Kim M, et al. Literacy-Adapted Cognitive Behavioral Therapy Versus Education for Chronic Pain at Low-Income Clinics: A Randomized Controlled Trial. Ann Intern Med. 2018;168: 471. doi: 10.7326/M17-0972 29482213

51. Figueroa JF, Lyon Z, Zhou X, Grabowski DC, Jha AK. Persistence and Drivers of High-Cost Status Among Dual-Eligible Medicare and Medicaid Beneficiaries: An Observational Study. Ann Intern Med. 2018;169: 528–534. doi: 10.7326/M18-0085 30285049

52. Otani K, Baden WW. Healthcare cost and predictive factors: high- and low-utilization model development. Health Mark Q. 2009;26: 198–208. doi: 10.1080/07359680903263599 19813123

53. Merkesdal S, Mau W. Prediction of costs-of-illness in patients with low back pain undergoing orthopedic outpatient rehabilitation. Int J Rehabil Res Int Z Rehabil Rev Int Rech Readaptation. 2005;28: 119–126. doi: 10.1097/00004356-200506000-00004 15900181

54. Charlson M, Wells MT, Ullman R, King F, Shmukler C. The Charlson comorbidity index can be used prospectively to identify patients who will incur high future costs. PloS One. 2014;9: e112479. doi: 10.1371/journal.pone.0112479 25469987

55. Rundell SD, Goode AP, Suri P, Heagerty PJ, Comstock BA, Friedly JL, et al. Effect of Comorbid Knee and Hip Osteoarthritis on Longitudinal Clinical and Health Care Use Outcomes in Older Adults With New Visits for Back Pain. Arch Phys Med Rehabil. 2017;98: 43–50. doi: 10.1016/j.apmr.2016.06.022 27519927

56. Luo X, Pietrobon R, Sun SX, Liu G, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States. Spine. 2004;29: 79–86. doi: 10.1097/01.BRS.0000105527.13866.0F 14699281

57. Colla CH, Morden NE, Sequist TD, Mainor AJ, Li Z, Rosenthal MB. Payer Type and Low-Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations. Health Serv Res. 2018;53: 730–746. doi: 10.1111/1475-6773.12665 28217968

58. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012. Vital Health Stat 10. 2014; 1–161.

59. US Census Bureau. Median age of the U.S. population 1960–2018. In: Statista [Internet]. [cited 19 Aug 2019]. https://www.statista.com/statistics/241494/median-age-of-the-us-population/

60. CDCMMWR. QuickStats: Percentage of Employed Adults Aged ≥18 Years with Any Work-Loss Days Because of Illness or Injury in the Past 12 Months, by Sex and Age Group—National Health Interview Survey, 2017. MMWR Morb Mortal Wkly Rep. 2019;68. doi: 10.15585/mmwr.mm6817a7 31048677

61. CDCMMWR. QuickStats: Percentage of Employed Adults Aged ≥18 Years with Any Work-Loss Days Because of Illness or Injury in the Past 12 Months, by Sex and Age Group—National Health Interview Survey, 2017. MMWR Morb Mortal Wkly Rep. 2019;68. doi: 10.15585/mmwr.mm6817a7 31048677

62. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299: 656–664. doi: 10.1001/jama.299.6.656 18270354


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