title: Challenges and solutions in the evaluation of a low back pain disease management program.
abstract: This paper examines a novel approach to evaluating a nurse-run telephonic low back pain (LBP) disease management (DM) program offered by a fully-insured commercial health plan population with approximately 150,000 members located in the northeastern United States. Members with at least 6 member months of eligibility were identified to have LBP using administrative claims and eligibility data. The LBP program relies on telephonic nurse management augmented by printed materials, adapting and advocating HEDIS imaging guidelines, and drug utilization review. Outcomes of this LBP DM program were assessed using a pre-post population-based approach as recommended in the DMAA Outcomes Guidelines Report. Baseline year and program year populations were segmented into 5 LBP clinical categories and each was weight adjusted using population size. LBP-related medical service utilization and pharmacy utilization also were evaluated. Individuals under active LBP management exhibited a decrease in LBP-related imaging and surgeries. Overall analgesic use also decreased. These data suggest the LBP DM program is associated with a decrease in imaging, surgeries, and analgesic use. The magnitude of the clinically segmented weight-adjusted return on investment (ROI) was lower than the unadjusted ROI, but was directionally positive indicating program impact. This adjustment is necessary in order to gain insight into and consistency of the results of a comprehensive LBP DM program evaluation.
authors.affiliation: Health Management Corporation, Chicago, Illinois, USA. tkotsos@choosehmc.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Kotsos
authors.forename: Kevin
authors.initials: K
authors.lastname: Muldowney
authors.forename: Griselda
authors.initials: G
authors.lastname: Chapa
authors.forename: J Eric
authors.initials: JE
authors.lastname: Martin
authors.forename: Antonio
authors.initials: A
authors.lastname: Linares
mesh_terms: D003362:Cost-Benefit Analysis; D019468:Disease Management; D017723:Drug Utilization Review; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D017116:Low Back Pain / Q000191:economics / Q000451:nursing*; D009511:New England; D009732:Nursing Care / Q000379:methods; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation