National Spine and Pain Centers, Rockville, MD; World Institute of Pain, Winston-Salem, NC.
National Spine and Pain Centers, Rockville, MD.
Pain Physician. 2023 Mar;26(2):207-217.
Poorly managed chronic spinal pain encumbers medical resources and drives healthcare costs, suggesting a target for improvement.
To determine how specialist-care pathways influence healthcare costs in the first year after a referral for chronic spine pain.
This was a retrospective cohort analysis of administrative claims from a large commercial health insurance provider, analyzing a 6-month baseline, a variable "pre-referral period," and a one-year period of specialist care.
US patients covered by private commercial insurers.
Adult patients diagnosed with chronic, spine-related pain between July 2016 and February 2018 and under the active care of a specialist were eligible. Patients with neurological deficits or cancer-related pain were excluded. Patients were categorized based on sequence-dependent exposure to a pain specialist, a surgeon, or both specialties. Key measures were pain-related and all-cause medical resource use and costs and opioid prescription fills.
Of 306,080 eligible patients (mean age 61.6; 61.5% women), 13% saw a pain specialist, 71% a surgeon, 7% a pain specialist then a surgeon, and 9% a surgeon then a pain specialist. Referral to a pain specialist alone was associated with lower resource use and per-patient adjusted cost savings of $3,311 (pain-related) and $6,447 (all-cause) compared to patients referred to a surgeon alone. The pain specialist pathway was associated with increased indicators of prescription opioid use.
Cohort design constraints temper the results' generalizability, given the need to simultaneously examine specialty pathway and medical resource incurred over the same time period.
We observed meaningful savings in cost and resource use when chronic spine-pain patients were managed by pain specialists. Pain-management referrals should be an element of a thoughtfully designed care pathway.
管理不善的慢性脊柱疼痛消耗了医疗资源并推高了医疗保健成本，这表明需要对此进行改进。
确定专科护理途径如何影响慢性脊柱疼痛转诊后第一年的医疗保健成本。
这是一项针对大型商业健康保险公司管理索赔数据的回顾性队列分析，分析了 6 个月的基线期、可变的“转诊前时期”以及一年的专科护理期。
美国私人商业保险公司承保的患者。
符合条件的患者为 2016 年 7 月至 2018 年 2 月期间被诊断为慢性、与脊柱相关疼痛且正在接受专科医生治疗的成年患者。排除有神经功能缺损或癌症相关疼痛的患者。根据患者是否按顺序接受疼痛专家、外科医生或两者的专科护理进行分类。主要指标为与疼痛相关的和所有原因的医疗资源使用和成本以及阿片类药物处方量。
在 306080 名符合条件的患者中（平均年龄 61.6 岁；61.5%为女性），13%的患者看了疼痛专家，71%的患者看了外科医生，7%的患者先看了疼痛专家然后看了外科医生，9%的患者先看了外科医生然后看了疼痛专家。与仅转诊给外科医生的患者相比，仅转诊给疼痛专家与较低的资源使用和每位患者调整后的成本节省相关，分别为 3311 美元（与疼痛相关）和 6447 美元（所有原因）。疼痛专家途径与处方阿片类药物使用的指标增加相关。
队列设计的限制限制了研究结果的普遍性，因为需要同时检查在同一时间段内发生的专科途径和医疗资源使用情况。
我们观察到慢性脊柱疼痛患者由疼痛专家管理时在成本和资源使用方面有显著节省。疼痛管理转诊应成为精心设计的护理途径的一个组成部分。
