Health Care Utilization and Costs Associated with Adherence to Clinical Practice Guidelines for Early Magnetic Resonance Imaging among Workers with Acute Occupational Low Back Pain
Article first published online: 1 AUG 2013
© Health Research and Educational Trust
Health Services Research
Volume 49, Issue 2, pages 645–665, April 2014
How to Cite
Graves, J. M., Fulton-Kehoe, D., Jarvik, J. G. and Franklin, G. M. (2014), Health Care Utilization and Costs Associated with Adherence to Clinical Practice Guidelines for Early Magnetic Resonance Imaging among Workers with Acute Occupational Low Back Pain. Health Services Research, 49: 645–665. doi: 10.1111/1475-6773.12098
- Issue published online: 27 MAR 2014
- Article first published online: 1 AUG 2013
- National Institute for Occupational Safety and Health. Grant Numbers: 1 R0 OH04069, 1 T42 OH008433
- Agency for Healthcare Research and Quality. Grant Number: R01 HS019222-01
- National Institutes of Health
- National Institute of Child Health and Human Development. Grant Number: T32 HD057822-01A2
- Low back pain;
- diagnostic imaging;
- clinical practice guidelines;
- workers' compensation
To estimate health care utilization and costs associated with adherence to clinical practice guidelines for the use of early magnetic resonance imaging (MRI; within the first 6 weeks of injury) for acute occupational low back pain (LBP).
Washington State Disability Risk Identification Study Cohort (D-RISC), consisting of administrative claims and patient interview data from workers’ compensation claimants (2002–2004).
In this prospective, population-based cohort study, we compared health care utilization and costs among workers whose imaging was adherent to guidelines (no early MRI) to workers whose imaging was not adherent to guidelines (early MRI in the absence of red flags).
Data Collection/Extraction Methods
We identified workers (age >18) with work-related LBP using administrative claims. We obtained demographic, injury, health, and employment information through telephone interviews to adjust for baseline differences between groups. We ascertained health care utilization and costs from administrative claims for 1 year following injury.
Of 1,770 workers, 336 (19.0 percent) were classified as nonadherent to guidelines. Outpatient and physical/occupational therapy utilization was 52–54 percent higher for workers whose imaging was not adherent to guidelines compared to workers with guideline-adherent imaging; utilization of chiropractic care was significantly lower (18 percent).
Nonadherence to guidelines for early MRI was associated with increased likelihood of lumbosacral injections or surgery and higher costs for out-patient, inpatient, and nonmedical services, and disability compensation.