COVID-19 对医疗保险人群慢性脊柱疼痛管理中硬膜外程序使用的影响。

The Influence of COVID-19 on Utilization of Epidural Procedures in Managing Chronic Spinal Pain in the Medicare Population.

机构信息

Pain Management Centers of America, Paducah, KY & Evansville, IN.

Advocate Illinois Masonic Medical Center and College of Medicine, University of Illinois, Chicago, IL.

出版信息

Spine (Phila Pa 1976). 2023 Jul 1;48(13):950-961. doi: 10.1097/BRS.0000000000004574. Epub 2022 Dec 28.

DOI:10.1097/BRS.0000000000004574

PMID:36728775

Abstract

STUDY DESIGN

A retrospective cohort study of utilization patterns and variables of epidural injections in the fee-for-service (FFS) Medicare population.

OBJECTIVES

To update the utilization of epidural injections in managing chronic pain in the FFS Medicare population, from 2000 to 2020, and assess the impact of COVID-19.

SUMMARY OF BACKGROUND DATA

The analysis of the utilization of interventional techniques also showed an annual decrease of 2.5% per 100,000 FFS Medicare enrollees from 2009 to 2018, contrasting to an annual increase of 7.3% from 2000 to 2009. The impact of the COVID-19 pandemic has not been assessed.

METHODS

This analysis was performed by utilizing master data from the Centers for Medicare and Medicaid Services, physician/supplier procedure summary from 2000 to 2020. The analysis was performed by the assessment of utilization patterns using guidance from Strengthening the Reporting of Observational Studies in Epidemiology.

RESULTS

Epidural procedures declined at a rate of 19% per 100,000 Medicare enrollees in the FFS Medicare population in the United States from 2019 to 2020, with an annual decline of 3% from 2010 to 2019. From 2000 to 2010, there was an annual increase of 8.3%. This analysis showed a decline in all categories of epidural procedures from 2019 to 2020. The major impact of COVID-19, with closures taking effect from April 1, 2020, through December 31, 2020, will be steeper and rather dramatic compared with April 1 to December 31, 2019. However, monthly data from the Centers for Medicare and Medicaid Services is not available as of now. Overall declines from 2010 to 2019 showed a decrease for cervical and thoracic transforaminal injections with an annual decrease of 5.6%, followed by lumbar interlaminar and caudal epidural injections of 4.9%, followed by 1.8% for lumbar/sacral transforaminal epidurals, and 0.9% for cervical and thoracic interlaminar epidurals.

CONCLUSION

Declining utilization of epidural injections in all categories was exacerbated to a decrease of 19% from 2019 to 2020, related, in part, to the COVID-19 pandemic. This followed declining patterns of epidural procedures of 3% overall annually from 2010 to 2019.

摘要

研究设计

一项回顾性队列研究，旨在调查在按服务项目付费（FFS）的医疗保险人群中，硬膜外注射的使用模式和变量。

目的

更新 2000 年至 2020 年期间 FFS 医疗保险人群中硬膜外注射治疗慢性疼痛的使用情况，并评估 COVID-19 的影响。

背景资料概要

干预技术使用情况的分析也显示，2009 年至 2018 年，每 10 万 FFS 医疗保险参保者中，每年硬膜外注射的使用量减少 2.5%，而 2000 年至 2009 年，每年的增长率为 7.3%。尚未评估 COVID-19 大流行的影响。

方法

本分析利用医疗保险和医疗补助服务中心的主数据以及 2000 年至 2020 年的医生/供应商程序摘要进行。使用加强观察性研究报告标准对使用模式进行评估。

结果

美国 FFS 医疗保险人群中，硬膜外治疗的病例数从 2019 年至 2020 年每年减少 19%，从 2010 年至 2019 年每年减少 3%。2000 年至 2010 年，每年增加 8.3%。本分析显示，2019 年至 2020 年所有硬膜外治疗类别均出现下降。COVID-19 的主要影响是，自 2020 年 4 月 1 日至 2020 年 12 月 31 日，实施关闭措施，与 2019 年 4 月 1 日至 12 月 31 日相比，情况将更加严重和显著。然而，截至目前，医疗保险和医疗补助服务中心还没有提供月度数据。2010 年至 2019 年总体下降显示，颈椎和胸椎经椎间孔硬膜外注射下降了 5.6%，腰椎间硬膜外和尾骨硬膜外注射下降了 4.9%，腰椎/骶骨经椎间孔硬膜外注射下降了 1.8%，颈椎和胸椎经椎间孔硬膜外注射下降了 0.9%。