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- (-) Back Health and Pain (8)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 8 of 8 Research Studies DisplayedGanguli I, Ying W, Shakley T
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
The purpose of this study was to examine the impact of low-value imaging on cascade services and spending in commercially-insured adults with uncomplicated acute low back pain. The researchers analyzed medical claims from Blue Cross Blue Shield of Massachusetts members aged 18-50 years who received a 2018 diagnosis of uncomplicated low back pain, for which imaging was considered inappropriate according to the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS) criteria. In 2018, 30,892 members were eligible for low-value imaging. Of these, 6009 (19.5%) received low-value imaging: 5091 (16.5%) X-ray and 787 (2.5%) MRI. The study found that when compared to patients without low-value imaging, those with low-value X-ray or MRI had higher adjusted probabilities of receiving cascade services and greater adjusted total spending at 3, 6, and 12 months. These results were robust to falsification testing. Members with high deductible health plans (HDHP) had higher narrowly defined cascade-associated out-of-pocket spending than those in other plans. The most common sources of narrowly defined cascade-associated spending were physical therapy, office visits, radiology studies, laboratory studies, and surgery.
J Gen Intern Med 2023 Mar;38(4):1102-05. doi: 10.1007/s11606-022-07829-2
Citation: Ganguli I, Ying W, Shakley T .
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
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Keywords: Imaging, Back Health and Pain, Pain, Healthcare Costs
Fenton JJ, Jerant A, Franks P
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
This paper describes the protocol that will be used for an upcoming randomized control trial to determine the effectiveness of teaching clinicians how to advise watchful waiting when patients request low-value spinal imaging for acute low back pain. The authors will recruit 8-10 primary care and urgent care clinics in Sacramento, California. The study will last 3-6 months and during this time clinicians in the intervention group with receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain. The SPIs will instruct clinicians in a 3-step model emphasizing trust, empathic communication, and negotiation of a watchful waiting approach. The primary outcome looked for will a decreased post-intervention rate of spinal imaging among actual patients with acute back pain compared to the rate of imaging during the baseline period. Secondary outcomes will include use of targeted communication techniques during a follow-up visit with an SP.
AHRQ-funded; HS026415.
Citation: Fenton JJ, Jerant A, Franks P .
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
Trials 2021 Feb 27;22(1):167. doi: 10.1186/s13063-021-05106-x..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Imaging, Diagnostic Safety and Quality, Clinician-Patient Communication, Communication
O'Reilly-Jacob M, Perloff J, Buerhaus P
Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care.
This study measures the rates of low-value back images ordered by primary care physicians and nurse practitioners for Medicare beneficiaries, and there was no detectable difference between the two groups in 2012 and 2013.
AHRQ-funded; HS00062.
Citation: O'Reilly-Jacob M, Perloff J, Buerhaus P .
Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care.
Nurs Outlook 2019 Nov - Dec;67(6):713-24. doi: 10.1016/j.outlook.2019.05.005..
Keywords: Imaging, Back Health and Pain, Primary Care, Imaging, Pain
Graves JM, Fulton-Kehoe D, Jarvik JG
Impact of an advanced imaging utilization review program on downstream health care utilization and costs for low back pain.
Investigators researched the impact of imaging tests such as magnetic resonance imaging (MRI) for lower back pain (LBP) on utilization and duration of workers’ compensation claims. Claims from 76,119 Washington State workers with LBP from 2006 to 2014 were used to see if a policy that implemented prospective utilization review (UR) for early MRI increased costs per claim, disability duration and the proportion of workers who received benefits. Results showed there were noticeable effects from MRI tests, but not computed tomography or surgery utilization.
AHRQ-funded; HS019222.
Citation: Graves JM, Fulton-Kehoe D, Jarvik JG .
Impact of an advanced imaging utilization review program on downstream health care utilization and costs for low back pain.
Med Care 2018 Jun;56(6):520-28. doi: 10.1097/mlr.0000000000000917..
Keywords: Back Health and Pain, Healthcare Utilization, Imaging, Pain
Tan A, Zhou J, Kuo YF
Variation among primary care physicians in the use of imaging for older patients with acute low back pain.
The authors sought to estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. They used Texas Medicare claims data and tracked whether each patient received lumbar imaging within 4 weeks of the initial visit. They found that the specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed and that the use of imaging by individual physicians was stable over time.
AHRQ-funded; HS022134.
Citation: Tan A, Zhou J, Kuo YF .
Variation among primary care physicians in the use of imaging for older patients with acute low back pain.
J Gen Intern Med 2016 Feb;31(2):156-63. doi: 10.1007/s11606-015-3475-3.
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Keywords: Back Health and Pain, Elderly, Imaging, Primary Care, Practice Patterns
Jarvik JG, Comstock BA, James KT
Lumbar Imaging with Reporting of Epidemiology (LIRE)--protocol for a pragmatic cluster randomized trial.
The researchers will conduct a pragmatic cluster randomized clinical trial to test the hypothesis that inserting data on the prevalence of incidental imaging findings into lumbar spine imaging reports for studies ordered by primary care providers will reduce subsequent spine-related interventions. Their primary outcome will be spine-related intervention intensity based on Relative Value Units (RVUs) during the following year.
AHRQ-funded; HS022982.
Citation: Jarvik JG, Comstock BA, James KT .
Lumbar Imaging with Reporting of Epidemiology (LIRE)--protocol for a pragmatic cluster randomized trial.
Contemp Clin Trials 2015 Nov;45(Pt B):157-63. doi: 10.1016/j.cct.2015.10.003.
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Keywords: Imaging, Back Health and Pain, Patient-Centered Outcomes Research
Jarvik JG, Gold LS, Comstock BA
Association of early imaging for back pain with clinical outcomes in older adults.
This study compared function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy. It found that early imaging was not associated with better 1-year outcomes. The researchers concluded that the value of early diagnostic imaging in older adults for back pain with radiculopathy is uncertain.
AHRQ-funded; HS019222, HS022972
Citation: Jarvik JG, Gold LS, Comstock BA .
Association of early imaging for back pain with clinical outcomes in older adults.
JAMA. 2015 Mar 17;313(11):1143-53. doi: 10.1001/jama.2015.1871..
Keywords: Back Health and Pain, Elderly, Primary Care, Outcomes, Diagnostic Safety and Quality, Imaging
Suri P, Boyko EJ, Goldberg J
Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK).
The researchers examined the association of incident lumbar MRI findings with two specific spine-related symptom outcomes: 1) incident chronic bothersome lower back pain, and 2) incident radicular symptoms such as pain, weakness, or sensation alterations in the lower extremity. They found that even when applying more specific definitions for spine-related symptom outcomes, few MRI findings show strong associations with symptom outcomes.
AHRQ-funded; HS019222
Citation: Suri P, Boyko EJ, Goldberg J .
Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK).
BMC Musculoskelet Disord. 2014 May 13;15:152. doi: 10.1186/1471-2474-15-152..
Keywords: Back Health and Pain, Chronic Conditions, Diagnostic Safety and Quality, Imaging, Pain