平价医疗法案实施前后 Medicare 人群慢性疼痛硬膜外程序使用的对比分析

Comparative Analysis of Utilization of Epidural Procedures in Managing Chronic Pain in the Medicare Population: Pre and Post Affordable Care Act.

机构信息

Pain Management Center of Paducah Paducah, KY, Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, and Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, New Orleans, LA.

Ohio Pain Clinic Centerville, Wright State University, Dayton, OH.

出版信息

Spine (Phila Pa 1976). 2019 Feb 1;44(3):220-232. doi: 10.1097/BRS.0000000000002785.

DOI:10.1097/BRS.0000000000002785

PMID:30005043

Abstract

STUDY DESIGN

A retrospective cohort study of utilization patterns of epidural injections.

OBJECTIVE

The aim of this study was to assess patterns of utilization and variables of in chronic spinal pain in the fee-for-service (FFS) Medicare population, with a comparative analysis of pre- and post-Affordable Care Act (ACA) data from 2000 to 2009 and 2009 to 2016.

SUMMARY OF BACKGROUND DATA

Over the years, utilization of interventional pain management techniques, specifically epidural injections have increased creating concern over costs and public health policy.

METHODS

The master data from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2016 was utilized to assess utilization patterns. The descriptive analysis of the database analysis was performed using guidance from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Multiple variables were analyzed based on the procedures, specialties, and geography.

RESULTS

Caudal and lumbar interlaminar epidural injections decreased 25% from 2009 to 2016 with an annual decrease of 4% in contrast to lumbosacral transforaminal epidural injection episodes, increasing at an annual rate of 0.3%. In contrast, lumbar interlaminar epidural injections increased 2.4% annually, while transforaminal episodes increased 23% from 2000 to 2009. The ratio of interlaminar epidural injections to transforaminal epidural injection episodes has changed from 7 in 2000 to 1 in 2016, whereas ratio of services changed from 5 to 0.7. From 2009 to 2016, cervical/thoracic interlaminar epidural injections episodes increased at an annual rate of 0.5%, with a decrease of 2.3% for transforaminal epidural injections.

CONCLUSION

Comparative analysis of the utilization of epidural injections from 2000 to 2009 and 2009 to 2016 showed vast differences with overall significant decreases in utilization, specifically for lumbar interlaminar and caudal epidural injections, with a continued, though greatly slowed increase of lumbosacral transforaminal epidural injections.

LEVEL OF EVIDENCE

摘要

研究设计

硬膜外注射利用模式的回顾性队列研究。

目的

本研究旨在评估在自费医疗保健（FFS）医疗保险人群中慢性脊柱疼痛的利用模式和变量，并对 2000 年至 2009 年和 2009 年至 2016 年《平价医疗法案》（ACA）前后的数据进行比较分析。

背景资料概要

多年来，介入性疼痛管理技术，特别是硬膜外注射的利用增加了，引起了对成本和公共卫生政策的关注。

方法

利用 2000 年至 2016 年医疗保险服务中心（CMS）医生/供应商程序摘要的主数据评估利用模式。使用《观察性研究的强化报告》（STROBE）的指导对数据库分析进行描述性分析。根据程序、专业和地理位置分析了多个变量。

结果

2009 年至 2016 年，腰骶部硬膜外腔下腔和腰椎间硬膜外腔注射减少了 25%，每年减少 4%，而腰骶部经椎间孔硬膜外注射次数增加，每年增加 0.3%。相比之下，腰椎间硬膜外腔注射每年增加 2.4%，而经椎间孔注射次数从 2000 年至 2009 年增加 23%。腰椎间硬膜外腔注射与经椎间孔硬膜外腔注射次数的比例从 2000 年的 7 变为 2016 年的 1，而服务比例从 5 变为 0.7。从 2009 年至 2016 年，颈椎/胸椎间硬膜外腔注射次数每年增加 0.5%，经椎间孔硬膜外腔注射次数减少 2.3%。