Neck pain care pathways and costs: association with the type of initial contact health care provider. A retrospective cohort study

Abstract

Background: For individuals with neck pain (NP) the initial contact health care provider (HCP) and subsequent services used are less well understood than for low back pain (LBP). The purpose of this retrospective observational study of administrative data was to examine the association between type of initial contact HCP, service utilization, and total episode cost for the management of NP. Methods: A US national sample of NP episodes completed in 2017-2019 was analyzed using episode of care as the unit of analysis. Separate analyses of a combined surgical and non-surgical (pooled) sample and a non-surgical sample were performed. Seventeen types of HCP initially contacted by an individual with NP was the primary independent variable. Dependent measures included rate and timing of use of fourteen types of health care services and total episode cost. A mixed effects model applied to pooled and non-surgical samples was used to test the association between initial contact HCP, total episode cost and rate of prescription opioid and NSAID use for NP. Results: The study included 323,348 continuously insured individuals aged 18 years and older with 390,992 complete episodes of NP involving 321,538 HCPs and incurring $472,399,064 in expenditures. 53.0% of episodes had initial contact with a primary care or specialist HCP, with these episodes associated with higher rates of imaging, pharmacologic, and interventional services. 40.4% of episodes had initial contact with a non-prescribing HCP, with these episodes associated with higher rates of non-pharmacological services. Adjusted total episode cost was lowest when a chiropractor was the initial contact HCP. Results were consistent for individuals experiencing single or multiple episodes during the study period. Conclusions: This study of a large national cohort of commercially insured individuals with NP helps fill a knowledge gap regarding NP care pathway attributes. Like LBP, the treatment of NP is highly variable with the initial HCP selected by an individual with NP associated with differences in services received and episode cost. Initial contact with a non-prescribing HCP was associated with lower rates of imaging, pharmacology, and interventional services.

Geographic variation in the treatment of spinal disorders: association with health care professional availability, and population socioeconomic status, race, and ethnicity. A retrospective cohort study

“…This study expands on earlier studies of the same LBP and NP cohorts 3,4 and contributes to the understanding of geographic variation in health care, and specifically variation in management of spinal disorders associated with environmental and population factors such as SES, race/ethnicity, and HCP availability.…”

“…It is unclear how these observed patterns are amplified or muted in a population with less or no coverage for guideline-recommended first-line services. This study expands on earlier studies of the same LBP and NP cohorts 3,4 and contributes to the understanding of geographic variation in health care, and specifically variation in management of spinal disorders associated with environmental and population factors such as SES, race/ethnicity, and HCP availability.…”

“…As demonstrated in earlier studies of the same underlying data the risk of episode misclassification bias is low. 3,4 Further minimizing this risk was the assumption that any misclassification bias associated with episode type would be similar within each ADI and percent NHW segment.…”

“…The rate and timing of use of 14 types of health care services was calculated. 3,4 Service utilization reflects services provided at any time by any type of HCP. Services were grouped into first-, second-, and third-line categories.…”

“…Spinal disorders are prevalent 1 , costly 2 , and a common reason for visiting a primary care provider (PCP). [3][4][5] . LBP clinical practice guidelines (CPGs) 6,7 describe a stepped approach to management 3,8,9 in which favorable natural history, self-care and non-pharmaceutical services are recommended as firstline approaches.…”