National Healthcare Quality and Disparities Report
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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
51 to 75 of 95 Research Studies DisplayedYoo BK, Schaffer SJ, Humiston SG
Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children.
This paper describes a clinical trial which created a school-located influenza vaccination (SLIV) program in upstate New York. Researchers wanted to determine if this was a cost-effective alternative to vaccination in primary care practices. Two groups of students were vaccinated – one in an elementary school and the other in a secondary school. Secondary school vaccinations were more cost-effective than elementary schools with a lower median cost per vaccination. The authors concluded that it does raise vaccination rates, but it is not cost-effective due to the higher costs for consent systems and project coordination.
AHRQ-funded; HS021163.
Citation: Yoo BK, Schaffer SJ, Humiston SG .
Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children.
BMC Health Serv Res 2019 Jun 24;19(1):407. doi: 10.1186/s12913-019-4228-5..
Keywords: Children/Adolescents, Education, Healthcare Costs, Influenza, Public Health, Vaccination
Khandelwal N, White L, Curtis JR
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
The objective of this study was to estimate out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and to examine how these costs vary by insurance coverage. Results showed that, across all categories of insurance coverage, out-of-pocket spending in the last 12 months of life was high and represented a significant portion of assets for many patients requiring intensive care and their families. Medicare fee-for-service alone did not insulate individuals from the financial burden of high-intensity care. Medicaid was found to provide the most complete hospital coverage of all the insurance groups, as well as significantly financing long-term care.
AHRQ-funded; HS022982.
Citation: Khandelwal N, White L, Curtis JR .
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
Crit Care Med 2019 Jun;47(6):749-56. doi: 10.1097/ccm.0000000000003723..
Keywords: Critical Care, Elderly, Health Insurance, Healthcare Costs, Intensive Care Unit (ICU), Medicaid, Medicare
Callaghan BC, Reynolds E, Banerjee M
Out-of-pocket costs are on the rise for commonly prescribed neurologic medications.
The purpose of this study was to determine out-of-pocket costs for neurologic medications in 5 common neurologic diseases. The investigators concluded that out-of-pocket costs for neurologic medications have increased considerably over the last 12 years, particularly for those in high-deductible health plans. Out-of-pocket costs vary widely both across and within conditions. They assert that to minimize patient financial burden, neurologists require access to precise cost information when making treatment decisions.
AHRQ-funded; HS022258.
Citation: Callaghan BC, Reynolds E, Banerjee M .
Out-of-pocket costs are on the rise for commonly prescribed neurologic medications.
Neurology 2019 May 28;92(22):e2604-e13. doi: 10.1212/wnl.0000000000007564.
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Keywords: Health Insurance, Healthcare Costs, Medication, Neurological Disorders
Delling FN, Vittinghoff E, Dewland TA
Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA.
Researchers studied whether the legalization of cannabis in Colorado has affected healthcare utilization compared to two states where it is still illegal (New York and Oklahoma). ICD-9 was used to determine changes in healthcare utilization relative to various medical diagnoses. According to the National Academy of Science (NAS), legal cannabis use creates an increase in cannabis abuse hospitalizations and also linked to motor vehicle accidents, alcohol abuse, and overdose injury and that was true in CO. There was not a change in hospital stays and costs in CO compared to NY and OK.
AHRQ-funded.
Citation: Delling FN, Vittinghoff E, Dewland TA .
Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA.
BMJ Open 2019 May 15;9(5):e027432. doi: 10.1136/bmjopen-2018-027432..
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Policy, Substance Abuse
Pisu M, Schoenberger YM, Herbey I
Perspectives on conversations about costs of cancer care of breast cancer survivors and cancer center staff: a qualitative study.
Despite recommendations to discuss the cost of care (CoC) with patients with cancer, little formal guidance is available on how to conduct these sensitive conversations in ways that are acceptable to both patients and providers. The objective of this study was to explore the perspectives of patients and medical and nonmedical cancer center staff on CoC conversations.
ARHQ-funded; HS023009.
Citation: Pisu M, Schoenberger YM, Herbey I .
Perspectives on conversations about costs of cancer care of breast cancer survivors and cancer center staff: a qualitative study.
Ann Intern Med 2019 May 7;170(9_Supplement):S54-s61. doi: 10.7326/m18-2117..
Keywords: Cancer: Breast Cancer, Cancer, Healthcare Costs, Clinician-Patient Communication, Communication
Shaker M, Greenhawt M
Estimation of health and economic benefits of commercial peanut immunotherapy products: a cost-effectiveness analysis.
The goal of this study was to evaluate critical inputs associated with the cost-effectiveness of epicutaneous peanut immunotherapy (EPIT) and peanut oral immunotherapy (POIT) from a societal perspective. In microsimulations with Markov modeling, virtual children aged 4 years over received EPIT, POIT, or no immunotherapy treatment. The main outcomes and measures were rates of therapy-associated adverse reactions; quality-of-life improvements associated with changes in tolerated peanut doses were modeled along with quality-adjusted life-years (QALY), anaphylaxis, therapy-associated anaphylaxis, and fatalities. The findings of this simulated analysis indicate that EPIT and POIT may be cost-effective, but the authors note that further research is needed.
AHRQ-funded; HS024599.
Citation: Shaker M, Greenhawt M .
Estimation of health and economic benefits of commercial peanut immunotherapy products: a cost-effectiveness analysis.
JAMA Netw Open 2019 May 3;2(5):e193242. doi: 10.1001/jamanetworkopen.2019.3242..
Keywords: Healthcare Costs, Outcomes, Respiratory Conditions, Treatments
Borza T, Oerline MK, Skolarus TA
Association between hospital participation in Medicare Shared Savings Program Accountable Care Organizations and readmission following major surgery.
Accountable Care Organizations (ACOs) and readmission rates following major surgery. A retrospective cohort study was conducted using a 20% national Medicare sample to identify beneficiaries undergoing 1 of 7 common surgical procedures: abdominal aortic aneurysm repair, colectomy, cystectomy, prostatectomy, lung resection, total knee arthroplasty, and total hip arthroplasty between 2010 and 2014. Thirty-day risk-adjusted readmission rates was the primary outcome studied. Out of 2974 hospitals in the study, 389 were ACO affiliated. While rates fell for both cohorts, ACO hospitals had a higher decrease in hospitalizations over the same time period.
AHRQ-funded; HS024728; HS024525.
Citation: Borza T, Oerline MK, Skolarus TA .
Association between hospital participation in Medicare Shared Savings Program Accountable Care Organizations and readmission following major surgery.
Ann Surg 2019 May;269(5):873-78. doi: 10.1097/sla.0000000000002737..
Keywords: Hospitals, Surgery, Hospital Readmissions, Medicare, Healthcare Costs, Healthcare Delivery
Mafi JN, Godoy-Travieso P, Wei E
Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system.
This study analyzed the effects of an intervention program to reduce preoperative costs for care in patients undergoing cataract surgery. Most surgery centers require a battery of tests before surgery is approved. All patients must undergo primary care visits with chest x-rays, laboratory tests, and electrocardiograms required for many of them depending on age and presence of other conditions. This case-control study was conducted at 2 academic safety-net medical centers, Los Angeles County and University of Southern California (LAC-USC) (intervention, n = 469) and Harbor-UCLA (University of California, Los Angeles) (control, n = 585), from April 13, 2015, through April 12, 2016, with 12 additional months (April 13, 2016, through April 13, 2017) to assess sustainability (intervention, n = 1002; control, n = 511). All preoperative care decreased in the intervention group and mostly decreased in the control group. Financial losses occurred at these centers, but there was an overall savings for patients and society. These findings suggest that this may be a barrier to eliminating low-value care.
AHRQ-funded; HS024067.
Citation: Mafi JN, Godoy-Travieso P, Wei E .
Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system.
JAMA Intern Med 2019 May;179(5):648-57. doi: 10.1001/jamainternmed.2018.8358..
Keywords: Healthcare Costs, Surgery, Eye Disease and Health, Quality Improvement, Quality of Care
Patel KR, Singam V, Vakharia pp
Measurement properties of three assessments of burden used in atopic dermatitis in adults.
The objectives of this study were to determine the content validity, construct validity, internal consistency, differential reporting, responsiveness, floor or ceiling effects and feasibility of the Dermatology Life Quality Index (DLQI), Itchy Quality of Life (ItchyQoL) and 5-dimensions (5-D) itch scales for assessing burden of AD in adults and to compare their performance.
AHRQ-funded; HS023011.
Citation: Patel KR, Singam V, Vakharia pp .
Measurement properties of three assessments of burden used in atopic dermatitis in adults.
Br J Dermatol 2019 May;180(5):1083-89. doi: 10.1111/bjd.17243..
Keywords: Skin Conditions, Healthcare Costs, Quality of Life
Aouad M, Brown TT, Whaley CM
Reference pricing: the case of screening colonoscopies.
In this study, the investigators studied the introduction of reference pricing to the California Public Employees' Retirement System. The investigators found a 10 percentage point increase in the share of patients using an ambulatory surgery center (ASC), leading to a $2300 to $1700 reduction in prices paid for patients who switched to ASCs. They indicated that their results suggested the use of ASCs had a causal effect on prices paid and had no negative effect on patient health outcomes.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Reference pricing: the case of screening colonoscopies.
J Health Econ 2019 May;65:246-59. doi: 10.1016/j.jhealeco.2019.03.002..
Keywords: Colonoscopy, Decision Making, Health Services Research (HSR), Healthcare Costs, Healthcare Delivery, Screening
Diaz-Perez MJ, Hanover R, Sites E
Producing comparable cost and quality results from all-payer claims databases.
This study describes how all-payer claims databases (APCDs) can produce comparable cost and quality results for 4 states using a multistate analysis. Data was used from 2014 commercial claims in Colorado, Massachusetts, Oregon, and Utah. The partners standardized the rules for including payers, data set elements, measure specifications, SAS code and adjustments for population differences in age and gender. A Uniform Data Structure file format was created which can be used across multiple population, measures, and research dimensions.
AHRQ-funded; HS024072.
Citation: Diaz-Perez MJ, Hanover R, Sites E .
Producing comparable cost and quality results from all-payer claims databases.
Am J Manag Care 2019 May;25(5):e138-e44..
Keywords: Healthcare Costs, Payment, Quality of Care
Wickwire EM, Albrecht JS, Towe MM
The impact of treatments for OSA on monetized health economic outcomes: a systematic review.
This article systematically reviews published literature on the impact of treatment for obstructive sleep apnea (OSA) on monetized health economic outcomes. Customized searches were conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases; 196 articles were selected for review, and 17 studies met the inclusion criteria and were included in the final synthesis. In these selected studies, positive airway pressure was the most common treatment modality, but oral appliances and surgical approaches were also included. Healthcare use (HCU) and quality-adjusted life years (QALYs) were most common health economic outcomes. The authors conclude that, although study methodologies varied widely, the evidence suggested that treatment of OSA was associated with favorable economic outcomes within accepted ranges of cost-effectiveness, as well as reduced HCU and monetized costs.
AHRQ-funded; HS024560.
Citation: Wickwire EM, Albrecht JS, Towe MM .
The impact of treatments for OSA on monetized health economic outcomes: a systematic review.
Chest 2019 May;155(5):947-61. doi: 10.1016/j.chest.2019.01.009..
Keywords: Sleep Problems, Respiratory Conditions, Healthcare Costs, Outcomes
Wedlock PT, Mitgang EA, Oron AP
Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines.
The lack of specific policies on how many children must be present at a vaccinating location before a healthcare worker can open a measles-containing vaccine (MCV) - i.e. the vial-opening threshold - has led to inconsistent practices, which can have wide-ranging systems effects. Using HERMES-generated simulation models of the routine immunization supply chains of Benin, Mozambique and Niger, the investigators evaluated the impact of different vial-opening thresholds (none, 30% of doses must be used, 60%) and MCV presentations (10-dose, 5-dose) on each supply chain.
AHRQ-funded; HS023317.
Citation: Wedlock PT, Mitgang EA, Oron AP .
Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines.
Vaccine 2019 Apr 17;37(17):2356-68. doi: 10.1016/j.vaccine.2019.03.017..
Keywords: Vaccination, Infectious Diseases, Healthcare Costs, Public Health
Chien AT, Toomey SL, Kuo DZ
Care quality and spending among commercially insured children with disabilities.
Researchers examined the prevalence of children with disabilities (CWD) within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. The cross-sectional study comprised over 1M person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged from 1 to 19 years. The researchers found that CWD were prevalent in the commercially insured population, with these children experiencing suboptimal levels of care which were comparable to non-CWD groups. They concluded that improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
AHRQ-funded; HS025299.
Citation: Chien AT, Toomey SL, Kuo DZ .
Care quality and spending among commercially insured children with disabilities.
Acad Pediatr 2019 Apr;19(3):291-99. doi: 10.1016/j.acap.2018.06.004..
Keywords: Quality of Care, Children/Adolescents, Disabilities, Healthcare Costs, Health Insurance
Krah NM, Bardsley T, Nelson R
Economic burden of home antimicrobial therapy: OPAT versus oral therapy.
There is increasing evidence that outpatient parenteral antimicrobial therapy (OPAT) is overused for children and that outcomes with oral therapy are equivalent. The objective of this study was to compare economic burden between OPAT and oral therapy, accounting for direct and indirect costs and caregiver quality of life (QoL). The investigators concluded that the overall burden of OPAT was substantially higher than that of oral therapy, including higher direct and indirect costs and greater impact on caregiver QoL.
AHRQ-funded; HS023320.
Citation: Krah NM, Bardsley T, Nelson R .
Economic burden of home antimicrobial therapy: OPAT versus oral therapy.
Hosp Pediatr 2019 Apr;9(4):234-40. doi: 10.1542/hpeds.201-0193.
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Keywords: Healthcare Costs, Children/Adolescents, Caregiving, Home Healthcare, Antimicrobial Stewardship, Antibiotics, Medication
Nasol E, Lindly OJ, Chavez AE
Unmet need and financial impact disparities for US children with ADHD.
The 5.1million US children with attention-deficit/hyperactivity disorder (ADHD) have pronounced needs in education, occupational and speech therapy, and medical and behavioral treatments. Given known associations of ADHD diagnosis with race/ethnicity and parent education, this study aimed to assess how measures of socioeconomic status correlate with both adverse family financial impact of ADHD and disparities in unmet treatment need for ADHD.
AHRQ-funded; HS000063.
Citation: Nasol E, Lindly OJ, Chavez AE .
Unmet need and financial impact disparities for US children with ADHD.
Acad Pediatr 2019 Apr;19(3):315-24. doi: 10.1016/j.acap.2018.09.001..
Keywords: Children/Adolescents, Behavioral Health, Healthcare Costs, Social Determinants of Health
Berry JG, Goodman DM, Coller RJ
Association of home respiratory equipment and supply use with health care resource utilization in children.
The purpose of this cohort study was to compare health care use and spending in children using vs not using respiratory medical equipment and supplies (RMES). The investigators found that the use of RMES was associated with high health care spending, especially with hospital and home health care. They suggest that population health initiatives in children may benefit from consideration of RMES in comprehensive risk assessment for health care spending.
AHRQ-funded; HS02513.
Citation: Berry JG, Goodman DM, Coller RJ .
Association of home respiratory equipment and supply use with health care resource utilization in children.
J Pediatr 2019 Apr;207:169-75.e2. doi: 10.1016/j.jpeds.2018.11.046..
Keywords: Children/Adolescents, Healthcare Costs, Healthcare Utilization, Home Healthcare, Respiratory Conditions
Yin LX, Padula WV, Gadkaree S
Health care costs and cost-effectiveness in laryngotracheal stenosis.
The goal of this study was to conduct a cost-effectiveness analysis comparing open reconstruction surgery versus endoscopic dilation in the treatment of laryngotracheal stenosis (LTS). Cricotracheal/tracheal resection (CTR/TR) and endoscopic dilation were compared at a willingness-to-pay threshold of $50,000 per quality-adjusted life year (QALY) over 5 and 10 years. Annual treatment costs were derived from the Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins University. The results indicate that patients with intubation-related stenosis have higher annual costs than idiopathic patients. The major risk factor for increased cost was etiology of stenosis. Although CTR/TR contributes significantly to cost in LTS, it is more cost-effective than endoscopic dilations for appropriately selected patients over the 5- and 10-year periods.
AHRQ-funded; HS000029.
Citation: Yin LX, Padula WV, Gadkaree S .
Health care costs and cost-effectiveness in laryngotracheal stenosis.
Otolaryngol Head Neck Surg 2019 Apr;160(4):679-86. doi: 10.1177/0194599818815068..
Keywords: Healthcare Costs, Surgery, Treatments
Post B, Ryan AM, Moloci NM
Physician participation in Medicare Accountable Care Organizations and spillovers in commercial spending.
The purpose of this retrospective, longitudinal study was to determine if physicians who participated in a Medicare Accountable Care Organization (ACO) reduced spending among their commercially insured patients in Michigan. Blue Cross Blue Shield of Michigan (BCBSM) claims data from 2010 to 2015 was used to compare patients who experienced a significant clinical episode and were seen by physicians who participated in a Medicare ACO with those whose physicians were not part of an ACO. The researchers conclude that physicians who participated in Medicare ACOs did not reduce spending among most of their commercially insured patients.
AHRQ-funded; HS024525; HS024728.
Citation: Post B, Ryan AM, Moloci NM .
Physician participation in Medicare Accountable Care Organizations and spillovers in commercial spending.
Med Care 2019 Apr;57(4):305-11. doi: 10.1097/mlr.0000000000001081..
Keywords: Health Insurance, Healthcare Costs, Medicare
Wickwire EM, Tom SE, Scharf SM
Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries.
The purpose of this study was to examine the impact of untreated insomnia on health care utilization (HCU) among a representative sample of Medicare beneficiaries. Insomnia was defined as the presence of at least one claim containing an insomnia-related diagnosis in any given year based on ICD-9 or at least one prescription filled for an insomnia-related medication in Part D prescription drug files. Researchers compared HCU in the year prior to insomnia diagnosis with non-sleep disordered controls during the same period. The researchers conclude that the individuals in this randomly selected, representative sample with untreated insomnia demonstrated increased HCU and costs across all points of service.
AHRQ-funded; HS024560.
Citation: Wickwire EM, Tom SE, Scharf SM .
Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries.
Sleep 2019 Apr;42(4). doi: 10.1093/sleep/zsz007..
Keywords: Healthcare Costs, Healthcare Utilization, Medicare, Sleep Problems
Biener AI, Decker SL, Rohde F
AHRQ Author: Deck SL, Rohde F
Source of increased health care spending in the United States.
This infographic depicts MEPS information for five medical conditions that account for nearly 1/3 of all medical expenditures in 2015. Factors include the difference in spending associated with these conditions; the number of people treated for them; per capita costs; and related ambulatory visits and prescription drug costs as a proportion of health expenditures.
AHRQ-authored.
Citation: Biener AI, Decker SL, Rohde F .
Source of increased health care spending in the United States.
JAMA 2019 Mar 26;321(12):1147. doi: 10.1001/jama.2019.0679..
Keywords: Chronic Conditions, Healthcare Costs, Healthcare Utilization, Medical Expenditure Panel Survey (MEPS)
Nuti SV, Li SX, Xu X
Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study.
This study compared costs among Medicare fee-for-service beneficiaries aged 65 and over hospitalized with acute myocardial infarction (AMI) from 2010 to 2013 in the Premiere Healthcare Database. The association of in-hospital and post-acute care resource utilization and outcomes was examined. Researchers concluded that greater resource utilization during hospitalization was not associated with meaning differences in costs or mortality rates after hospitalization.
AHRQ-funded; HS023000.
Citation: Nuti SV, Li SX, Xu X .
Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study.
BMC Health Serv Res 2019 Mar 25;19(1):190. doi: 10.1186/s12913-019-4018-0..
Keywords: Cardiovascular Conditions, Elderly, Healthcare Costs, Hospitalization, Medicare
Shubeck SP, Thumma JR, Dimick JB
Hot spotting as a strategy to identify high-cost surgical populations.
Prospective identification of high-cost patients, known as "hot spotting," is well developed in medical populations, but has not been performed in surgical populations. Population-based management of surgical expenditures requires identification of high-cost surgical patients to allow for effective implementation of cost-saving strategies. The aim of this study was to determine the feasibility of "hot spotting" in elective surgical populations. The investigators found that a subset of multimorbid patients was responsible for a disproportionate share of total Medicare spending, but the individual components of spending vary by procedure.
AHRQ-funded; HS024763.
Citation: Shubeck SP, Thumma JR, Dimick JB .
Hot spotting as a strategy to identify high-cost surgical populations.
Ann Surg 2019 Mar;269(3):453-58. doi: 10.1097/sla.0000000000002663..
Keywords: Surgery, Healthcare Costs, Medicare
Dinan MA, Wilson LE, Reed SD
Chemotherapy costs and 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2005 to 2011.
This study examined whether associations between 21-gene recurrence score (RS) genomic testing and lower costs among patients with early-stage, estrogen receptor-positive breast cancer were observable in real-world data from the Medicare population. The investigators found that RS testing was associated with lower overall and chemotherapy-related costs in patients with high-risk disease, consistent with lower chemotherapy use among these patients. Higher overall costs for patients with intermediate-risk and low-risk disease were driven largely by non-treatment-related costs.
AHRQ-funded; HS022189.
Citation: Dinan MA, Wilson LE, Reed SD .
Chemotherapy costs and 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2005 to 2011.
J Natl Compr Canc Netw 2019 Mar;17(3):245-54. doi: 10.6004/jnccn.2018.7097..
Keywords: Cancer, Cancer: Breast Cancer, Treatments, Genetics, Healthcare Costs, Medicare, Women
Martin BI, Mirza SK, Spina N
Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015.
This study analyzed trends in lumbar fusion procedure rates for degenerative spinal diseases in the US from 2004 to 2015 as well as associated hospital costs. Spinal fusion is considered an appropriate procedure for spinal deformity and instability, but has limited evidence of effectiveness for primary disc herniation and spinal stenosis without instability. The analysis showed that aggregate hospital costs increased 177% during the analysis period with disc degeneration, herniation and stenosis accounted for 42.3% of the elective surgery. The largest increases in the elective surgery were for spondylolisthesis and scoliosis and has slightly decreased for those procedures with less evidence of effectiveness.
AHRQ-funded; HS024714.
Citation: Martin BI, Mirza SK, Spina N .
Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015.
Spine 2019 Mar 1;44(5):369-76. doi: 10.1097/brs.0000000000002822..
Keywords: Back Health and Pain, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Surgery