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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

Authors

  • Janessa M. Graves,

    Corresponding author
    1. Harborview Injury Prevention and Research Center, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
    • Address correspondence to Janessa M. Graves, M.P.H., Ph.D., Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Avenue, Seattle, WA 98104-2499; e-mail: janessa@uw.edu.

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  • Deborah Fulton-Kehoe,

    1. Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
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  • Jeffrey G. Jarvik,

    1. Departments of Radiology and Neurological Surgery, Comparative Effectiveness, Cost & Outcomes Research Center, School of Medicine, Department of Health Services, School of Public Health, University of Washington, Seattle, WA
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  • Gary M. Franklin

    1. Departments of Environmental & Occupational Health Sciences, Neurology, and Health Services, School of Public Health and School of Medicine, University of Washington, Seattle, WA
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Abstract

Objective

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).

Data Sources

Washington State Disability Risk Identification Study Cohort (D-RISC), consisting of administrative claims and patient interview data from workers’ compensation claimants (2002–2004).

Study Design

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.

Principal Findings

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).

Conclusions

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.

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