Yuan Xiaoning, Pav Veronika, Colahan Courtney, Miller Matthew E, Hager Nelson A, Pasquina Paul F, Cohen Steven P, Isaacson Brad M
Department of Physical Medicine and Rehabilitation, Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR), Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Kennell and Associates, Inc., Falls Church, VA 22042, USA.
Mil Med. 2023 Jul 22;188(7-8):e2387-e2396. doi: 10.1093/milmed/usac363.
Low back pain (LBP) has accounted for the most medical encounters every year for the past decade among Active Duty Service Members (ADSMs) of the U.S. Armed Forces. The objectives of this retrospective, descriptive study were to classify LBP by clinical category (Axial, Radicular, and Other) and duration (Acute, Subacute, and Chronic) and examine the LBP-related health care utilization, access to care, and private sector costs for ADSMs over a 2-year follow-up period.
The Military Health System Data Repository was queried in fiscal year 2017 for all ADSMs (ages 18-62) with outpatient encounters documented with any of 67 ICD-10 diagnosis codes indicative of LBP. A 1-year clean period before the first (index) outpatient LBP encounter date was used to ensure no recent history of LBP care. Patients were eligible if continuously enrolled and on active duty for 1 year before and 2 years following the index visit. Patients were excluded for non-musculoskeletal causes for LBP, red flags, or acute trauma within 4 weeks of the index visit and/or systemic illness or pregnancy anytime during the clean or follow-up period.
A total of 52,118 ADSMs met the inclusion criteria, and the cohort was classified by duration of LBP symptoms as Acute [17,916 (34.4%)], Subacute [4,119 (7.9%)], and Chronic [30,083 (57.7%)]. Over 2-year follow-up, 419,983 outpatient visits were recorded, with the majority occurring at MTFs [363,570 (86.6%)]. 13,237 (25.4%) of ADSMs in the total cohort were documented with no other LBP-related visits beyond their index encounter. In contrast, the Chronic cohort comprised the highest number of encounters [371,031 (89.2% of total encounters)], including 86% of imaging studies performed for LBP, and accounted for $9,986,606.17 (94.9%) of total private sector costs over the 2-year follow-up period. Interventional pain procedures ($2,983,767.50) and physical therapy ($2,298,779.07) represented the costliest categories in the private sector for the Chronic cohort, whereas Emergency Department ($283,307.43) and physical therapy ($137,035.54) encounters were the top contributors to private sector costs for the Acute and Subacute cohorts, respectively. Overall reliance on the private sector was highest for specialty care, including 10,721 (75.4%) interventional pain procedures and 306 (66.4%) spine surgeries.
Uncovering current trends in health care utilization and access to care for ADSMs newly presenting with LBP is vital for timely and accurate diagnosis, as well as early intervention to prevent progression to chronic LBP and to minimize its negative impact on military readiness and quality of life. This retrospective, descriptive study highlights the burden of chronic LBP on health care utilization and costs within the Military Health System, including reliance on the private sector care, amounting to $10,524,332.04 over the study period.
在过去十年中，腰痛（LBP）在美国武装部队现役军人（ADSM）每年的医疗就诊中占比最高。这项回顾性描述性研究的目的是按临床类别（轴向性、根性和其他）和持续时间（急性、亚急性和慢性）对腰痛进行分类，并在两年的随访期内检查ADSM与腰痛相关的医疗保健利用情况、就医机会以及私营部门成本。
2017财年，在军事卫生系统数据存储库中查询了所有（年龄在18 - 62岁之间）门诊就诊记录中有67个表明腰痛的ICD - 10诊断代码之一的ADSM。在首次（索引）门诊腰痛就诊日期前1年的清洁期用于确保近期无腰痛治疗史。如果患者在索引就诊前1年和就诊后2年连续注册并现役，则符合条件。因非肌肉骨骼原因导致的腰痛、警示信号或在索引就诊后4周内的急性创伤和/或在清洁期或随访期内的任何时间的全身性疾病或怀孕而排除患者。
共有52,118名ADSM符合纳入标准，该队列按腰痛症状持续时间分类为急性[17,916例（34.4%）]、亚急性[4,119例（7.9%）]和慢性[30,083例（57.7%）]。在两年的随访期内，记录了419,983次门诊就诊，其中大多数发生在军事治疗设施[363,570次（86.6%）]。在整个队列中，13,237名（25.4%）ADSM除索引就诊外无其他与腰痛相关的就诊记录。相比之下，慢性队列的就诊次数最多[371,031次（占总就诊次数的89.2%）]，包括为腰痛进行的影像学检查的86%，并且在两年的随访期内占私营部门总成本的9,986,606.17美元（94.9%）。介入性疼痛治疗（2,983,767.50美元）和物理治疗（2,298,779.07美元）在私营部门中是慢性队列中成本最高的类别，而急诊科就诊（283,307.43美元）和物理治疗就诊（137,035.54美元）分别是急性和亚急性队列私营部门成本的主要贡献者。总体而言，专科护理对私营部门的依赖最高，包括10,721次（75.4%）介入性疼痛治疗和306次（66.4%）脊柱手术。
发现新出现腰痛的ADSM的当前医疗保健利用趋势和就医机会对于及时准确的诊断以及早期干预以防止进展为慢性腰痛并尽量减少其对军事准备状态和生活质量的负面影响至关重要。这项回顾性描述性研究突出了慢性腰痛对军事卫生系统内医疗保健利用和成本的负担，包括对私营部门护理的依赖，在研究期间总计达10,524,332.04美元。
