Shafrin Jason, Griffith Jenny, Shim Jin Joo, Huber Caroline, Ganguli Arijit, Aubry Wade
1 Precision Health Economics, Los Angeles, CA, USA.
2 AbbVie Inc, North Chicago, IL, USA.
Inquiry. 2017 Jan 1;54:46958017707873. doi: 10.1177/0046958017707873.
Studies examining geographic variation in care for low back pain often focus on process and outcome measures conditional on patient diagnosis but generally do not take into account a physician's ability to diagnose the root cause of low back pain. In our case study, we used increased detection of ankylosing spondylitis-a relatively rare inflammatory back disease-as a proxy for diagnostic ability and measured the relationship between ankylosing spondylitis detection, potentially inappropriate low back pain care, and cost. Using 5 years of health insurance claims data, we found significant variation in ankylosing spondylitis detection across metropolitan statistical areas (MSAs), with 8.1% of the variation in detection explained by a region's racial composition. Furthermore, low back pain patients in MSAs with higher ankylosing spondylitis detection had 7.9% lower use of corticosteroids, 9.0% lower use of opioids, and 8.2% lower pharmacy cost, compared with patients living in low-detection MSAs.
研究腰痛护理的地理差异时，通常关注基于患者诊断的过程和结果指标，但一般未考虑医生诊断腰痛根本原因的能力。在我们的案例研究中，我们将强直性脊柱炎（一种相对罕见的炎性背痛疾病）检测率的提高作为诊断能力的替代指标，并测量了强直性脊柱炎检测、潜在不适当的腰痛护理与成本之间的关系。利用5年的医疗保险理赔数据，我们发现大都市统计区（MSA）之间强直性脊柱炎检测存在显著差异，其中8.1%的检测差异可由地区种族构成解释。此外，与生活在低检测率MSA的患者相比，强直性脊柱炎检测率较高的MSA中的腰痛患者使用皮质类固醇的比例低7.9%，使用阿片类药物的比例低9.0%，药房成本低8.2%。
