Mayo Clinic Arizona, Scottsdale, Arizona.
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado.
J Am Coll Radiol. 2017 Dec;14(12):1545-1551. doi: 10.1016/j.jacr.2017.07.012. Epub 2017 Aug 31.
OP-8 is the Medicare imaging efficiency metric for MRI of the lumbar spine for low back pain in the outpatient hospital. We studied trends in exclusion criteria coding over time by site of service after implementation of OP-8 to evaluate provider's response to public reporting.
We conducted a secondary data analysis using the Medicare Limited Data Set 5% sample for beneficiaries with MRI lumbar spine and lower back pain during 2009 to 2014. We evaluated the association between excluding condition prevalence and site by using generalized estimating equations regression. We produced model-based estimates of excluding condition prevalence by site and year. As a sensitivity analysis, we repeated the analysis while including additional conditions in the outcome measure.
We included 285,911 MRIs of the lumbar spine for low back pain. Generalized estimating equations regression found that outpatient hospitals had a higher proportion of MRIs with at least one excluding condition documented compared with outpatient clinics (P < .05), but increases in excluding condition prevalence were similar across all sites during 2009 to 2014. Our results were not sensitive to the inclusion of additional conditions.
Documentation of excluding conditions and other clinically reasonable exclusions for OP-8 increased over time for outpatient hospitals and clinics. Increases in documentation of comorbidities may not translate to actual improvement in imaging appropriateness for low back pain. When accounting for all relevant conditions, the proportion of patients with low back pain considered uncomplicated and being measured by OP-8 would be small, reflecting a small proportion of patients with low back pain.
OP-8 是医疗保险对门诊医院腰痛腰椎磁共振成像的成像效率指标。在实施 OP-8 后，我们通过服务地点研究了随时间推移排除标准编码的趋势，以评估提供者对公开报告的反应。
我们使用医疗保险有限数据集 5%的样本对 2009 年至 2014 年期间患有 MRI 腰椎和下腰痛的患者进行了二次数据分析。我们通过广义估计方程回归评估了排除条件患病率与地点之间的关系。我们通过站点和年份制作了排除条件患病率的基于模型的估计。作为敏感性分析，我们在将其他条件纳入结果衡量标准的情况下重复了分析。
我们共纳入了 285911 例腰痛的腰椎磁共振成像。广义估计方程回归发现，与门诊诊所相比，门诊医院记录的至少有一个排除条件的 MRI 比例更高（P<.05），但在 2009 年至 2014 年期间，所有站点的排除条件患病率增加情况相似。我们的结果对纳入其他条件不敏感。
对于门诊医院和诊所来说，记录排除条件和其他符合临床合理排除标准的 OP-8 随时间推移而增加。伴随记录合并症的增加可能并不意味着腰痛成像的适当性实际有所提高。在考虑所有相关条件的情况下，被认为不复杂且由 OP-8 测量的腰痛患者比例很小，反映了腰痛患者的一小部分。
