Department of Family and Community Medicine, University of California, Davis, Sacramento, CA.
Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA.
Spine (Phila Pa 1976). 2023 Oct 15;48(20):1409-1418. doi: 10.1097/BRS.0000000000004781. Epub 2023 Aug 1.
Retrospective cohort study.
To compare utilization patterns for patients with new-onset neck pain by initial provider specialty.
Initial provider specialty has been associated with distinct care patterns among patients with acute back pain; little is known about care patterns among patients with acute neck pain.
De-identified administrative claims and electronic health record data were derived from the Optum Labs Data Warehouse, which contains longitudinal health information on over 200M enrollees and patients representing a mixture of ages and geographical regions across the United States. Patients had outpatient visits for new-onset neck pain from October 1, 2016 to September 30, 2019, classified by initial provider specialty. Utilization was assessed during a 180-day follow-up period, including subsequent neck pain visits, diagnostic imaging, and therapeutic interventions.
The cohort included 770,326 patients with new-onset neck pain visits. The most common initial provider specialty was chiropractor (45.2%), followed by primary care (33.4%). Initial provider specialty was strongly associated with the receipt of subsequent neck pain visits with the same provider specialty. Rates and types of diagnostic imaging and therapeutic interventions during follow-up also varied widely by initial provider specialty. While uncommon after initial visits with chiropractors (≤2%), CT, or MRI scans occurred in over 30% of patients with initial visits with emergency physicians, orthopedists, or neurologists. Similarly, 6.8% and 3.4% of patients initially seen by orthopedists received therapeutic injections and major surgery, respectively, compared with 0.4% and 0.1% of patients initially seen by a chiropractor.
Within a large national cohort, chiropractors were the initial provider for a plurality of patients with new-onset neck pain. Compared with patients initially seen by physician providers, patients treated initially by chiropractors or therapists received fewer and less costly imaging services and were less likely to receive invasive therapeutic interventions during follow-up.
回顾性队列研究。
比较新发性颈痛患者初始就诊专业医生的利用模式。
初始就诊专业医生与急性背痛患者的不同护理模式有关；对于急性颈痛患者的护理模式，知之甚少。
从 Optum Labs 数据仓库中提取匿名行政索赔和电子健康记录数据，该数据仓库包含超过 2 亿名参保人和患者的纵向健康信息，代表美国各地不同年龄和地理区域的混合人群。2016 年 10 月 1 日至 2019 年 9 月 30 日，患者因新发颈痛就诊，根据初始就诊专业医生进行分类。在 180 天的随访期间评估利用情况，包括后续颈痛就诊、诊断性影像学检查和治疗性干预。
队列包括 770326 例新发颈痛就诊患者。最常见的初始就诊专业医生是脊椎按摩师（45.2%），其次是初级保健医生（33.4%）。初始就诊专业医生与接受同一专业医生的后续颈痛就诊密切相关。在随访期间，诊断性影像学检查和治疗性干预的类型和类型也因初始就诊专业医生而异。虽然在初次就诊时使用较少（≤2%），但 CT 或 MRI 扫描在初始就诊于急诊医生、骨科医生或神经科医生的患者中发生率超过 30%。同样，与初始就诊于脊椎按摩师的患者（0.4%）相比，6.8%和 3.4%的骨科医生就诊患者分别接受了治疗性注射和大手术，而接受治疗性注射和大手术的患者比例分别为 0.1%。
在一个大型的全国队列中，脊椎按摩师是大多数新发颈痛患者的初始就诊医生。与最初由医生就诊的患者相比，最初由脊椎按摩师或治疗师治疗的患者接受的影像学服务较少且费用较低，在随访期间接受侵入性治疗干预的可能性也较低。
3 级。
