Shi Weibin, Agbese Edeanya, Solaiman Adnan Z, Leslie Douglas L, Gater David R
Physical Medicine and Rehabilitation, Penn State Health Milton S Hershey Medical Center, Hershey, PA.
Pennsylvania State Hershey Rehabilitation Hospital, Hummelstown, PA.
Arch Rehabil Res Clin Transl. 2020 May 19;2(3):100060. doi: 10.1016/j.arrct.2020.100060. eCollection 2020 Sep.
To examine the utilization of current common treatments by providers from different specialties and the effect on delaying spinal surgery in patients with disk degenerative disease (DDD) related low back pain.
Retrospective observational study using data from the MarketScan Commercial Claims and Encounters database (2005-2013).
Not applicable.
Patients (N=6229) newly diagnosed with DDD-related low back pain who received interventional treatments from only 1 provider specialty and continuously enrolled in the database for 3 years after diagnosis.
Measures of treatment utilization and cost were constructed for patients who received spinal surgery within 3 years after diagnosis. Cox proportional hazards models were used to examine time to surgery among provider specialties and generalized linear models were used to examine cost differences among provider specialties.
Of the 6229 patients, 427 (6.86%) underwent spinal surgery with unadjusted mean interventional treatment costs ranging from $555 to $851. Although the differences in mean costs across provider specialties were large, they were not statistically significant. Cox proportional hazards models showed that there was no significant difference between provider specialties in the time from DDD diagnosis to spinal surgery. However, patients diagnosed with DDD at a younger age and receiving physical therapy had significantly delayed time to surgery (hazard ratio, 0.66; 95% confidence interval [CI], 0.54-0.81 and hazard ratio, 0.77; 95% CI, 0.62-0.96, respectively).
Although there were no statistically significant differences among provider specialties for time to surgery and cost, patients receiving physical therapy had significantly delayed time to surgery.
研究不同专科医生对当前常用治疗方法的使用情况，以及其对椎间盘退变疾病（DDD）相关下腰痛患者延迟脊柱手术的影响。
利用MarketScan商业索赔与病历数据库（2005 - 2013年）数据进行的回顾性观察研究。
不适用。
新诊断为DDD相关下腰痛的患者（N = 6229），这些患者仅接受了1个专科医生的介入治疗，且诊断后连续3年纳入数据库。
为诊断后3年内接受脊柱手术的患者构建治疗利用和成本指标。采用Cox比例风险模型研究各专科医生的手术时间，采用广义线性模型研究各专科医生的成本差异。
6229例患者中，427例（6.86%）接受了脊柱手术，未调整的平均介入治疗成本在555美元至851美元之间。尽管各专科医生的平均成本差异很大，但无统计学意义。Cox比例风险模型显示各专科医生从DDD诊断到脊柱手术的时间无显著差异。然而，诊断时年龄较小且接受物理治疗的患者手术时间显著延迟（风险比分别为0.66；95%置信区间[CI]，0.54 - 0.81和风险比0.77；95% CI，0.62 - 0.96）。
尽管各专科医生在手术时间和成本方面无统计学显著差异，但接受物理治疗的患者手术时间显著延迟。
