评估 2000 年至 2011 年医疗保险人群硬膜外注射的增长情况。

Assessment of the growth of epidural injections in the medicare population from 2000 to 2011.

机构信息

Pain Management Center of Paducah, Paducah, KY, USA.

出版信息

Pain Physician. 2013 Jul-Aug;16(4):E349-64.

Abstract

BACKGROUND

Among the many diagnostic and therapeutic interventions available for the management of chronic pain, epidural steroid injections are one of the most commonly used modalities. The explosive growth of this technique is relevant in light of the high cost of health care in the United States and abroad, the previous literature assessing the effectiveness of epidural injections has been sparse with highly variable outcomes based on technique, outcome measures, patient selection, and methodology. However, the recent assessment of fluoroscopically directed epidural injections has shown improved evidence with proper inclusion criteria, methodology, and outcome measures. The exponential growth of epidural injections is illustrated in multiple reports. The present report is an update of the analysis of the growth of epidural injections in the Medicare population from 2000 to 2011 in the United States.

STUDY DESIGN

Analysis of utilization patterns of epidural procedures in the Medicare population in the United States from 2000 to 2011.

OBJECTIVES

The primary purpose of this assessment was to evaluate the use of all types of epidural injections (i.e., caudal, interlaminar, and transforaminal in the lumbar, cervical, and thoracic regions) with an assessment of specialty and regional characteristics.

METHODS

This assessment was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011.

RESULTS

Epidural injections in Medicare beneficiaries increased significantly from 2000 to 2011. Overall, epidural injections increased 130% per 100,000 Medicare beneficiaries with an annual increase of 7.5%. The increases per 100,000 Medicare recipients were 123% for cervical/thoracic interlaminar epidural injections; 25% for lumbar/sacral interlaminar, or caudal epidural injections; 142% for cervical/thoracic transforaminal epidural injections; and 665% for lumbar/sacral transforaminal epidural injections. The use of epidurals increased 224% in the radiologic specialties (interventional radiology and diagnostic radiology) and 145% in psychiatric settings, whereas and physical medicine and rehabilitation physicians' use of epidurals increased 520%.

LIMITATIONS

Study limitatations include lack of inclusion of Medicare Advantage patients. In addition, the statewide data is based on claims which may include the contiguous or other states.

CONCLUSIONS

Epidural injections in Medicare recipients increased significantly. The growth was significant for some specialties (radiology, physical medicine and rehabilitation, and psychiatry) and for certain procedures (lumbosacral transforaminal epidural injections).

摘要

背景

在慢性疼痛管理的众多诊断和治疗干预措施中，硬膜外类固醇注射是最常用的方法之一。鉴于美国和国外医疗保健成本高昂，这项技术的爆炸式增长具有重要意义，以前评估硬膜外注射效果的文献很少，其结果因技术、结果测量、患者选择和方法而异。然而，最近对透视引导硬膜外注射的评估显示，在适当纳入标准、方法和结果测量的情况下，证据得到了改善。硬膜外注射的指数增长在多项报告中都有体现。本报告是对美国 2000 年至 2011 年医疗保险人群中硬膜外注射增长的分析更新。

研究设计

分析美国 2000 年至 2011 年医疗保险人群中硬膜外程序的使用模式。

目的

本次评估的主要目的是评估所有类型硬膜外注射（即腰骶部、颈椎和胸椎的骶管、椎板间和经椎间孔）的使用情况，并评估专业和区域特征。

方法

本评估利用 2000 年至 2011 年医疗保险和医疗补助服务中心（CMS）医生/供应商程序摘要（PSPS）主数据进行。

结果

医疗保险受益人的硬膜外注射从 2000 年到 2011 年显著增加。总体而言，硬膜外注射每 10 万医疗保险受益人增加 130%，每年增加 7.5%。每 10 万 Medicare 受助人的增长率为：颈椎/胸椎椎板间硬膜外注射增加 123%；腰骶部/骶管椎板间或骶管硬膜外注射增加 25%；颈椎/胸椎经椎间孔硬膜外注射增加 142%；腰骶部/骶骨经椎间孔硬膜外注射增加 665%。放射科（介入放射学和诊断放射学）和精神病学领域的硬膜外使用率增加了 224%，而物理医学和康复医生的硬膜外使用率增加了 520%。