title: Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain.
abstract: OBJECTIVE
  To estimate health care utilization and costs associated with adherence to clinical practice guidelines for the use of early magnetic resonance imaging (MRI; within the first 6 weeks of injury) for acute occupational low back pain (LBP).
  
  
  METHODS
  Washington State Disability Risk Identification Study Cohort (D-RISC), consisting of administrative claims and patient interview data from workers' compensation claimants (2002-2004).
  
  
  METHODS
  In this prospective, population-based cohort study, we compared health care utilization and costs among workers whose imaging was adherent to guidelines (no early MRI) to workers whose imaging was not adherent to guidelines (early MRI in the absence of red flags).
  
  
  METHODS
  We identified workers (age>18) with work-related LBP using administrative claims. We obtained demographic, injury, health, and employment information through telephone interviews to adjust for baseline differences between groups. We ascertained health care utilization and costs from administrative claims for 1 year following injury.
  
  
  RESULTS
  Of 1,770 workers, 336 (19.0 percent) were classified as nonadherent to guidelines. Outpatient and physical/occupational therapy utilization was 52-54 percent higher for workers whose imaging was not adherent to guidelines compared to workers with guideline-adherent imaging; utilization of chiropractic care was significantly lower (18 percent).
  
  
  CONCLUSIONS
  Nonadherence to guidelines for early MRI was associated with increased likelihood of lumbosacral injections or surgery and higher costs for out-patient, inpatient, and nonmedical services, and disability compensation.
authors.affiliation: Harborview Injury Prevention and Research Center, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Janessa M
authors.initials: JM
authors.lastname: Graves
authors.forename: Deborah
authors.initials: D
authors.lastname: Fulton-Kehoe
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
authors.forename: Gary M
authors.initials: GM
authors.lastname: Franklin
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D017116:Low Back Pain / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D012959:Socioeconomic Factors; D014861:Washington / Q000453:epidemiology; D014942:Workers' Compensation
keywords: Low back pain; clinical practice guidelines; costs; diagnostic imaging; utilization; workers' compensation
references.citation: Pain. 1992 Aug;50(2):133-149
references.pmid: 1408309
references.citation: J Occup Environ Med. 2010 Sep;52(9):900-7
references.pmid: 20798647
references.citation: Stat Med. 1998 Oct 15;17(19):2265-81
references.pmid: 9802183
references.citation: J Pain. 2006 Oct;7(10):718-25
references.pmid: 17018332
references.citation: Ann Intern Med. 2007 Oct 2;147(7):478-91
references.pmid: 17909209
references.citation: Am J Epidemiol. 2004 Apr 1;159(7):702-6
references.pmid: 15033648
references.citation: J Health Econ. 1999 Apr;18(2):153-71
references.pmid: 10346351
references.citation: Pain. 1993 Feb;52(2):157-168
references.pmid: 8455963
references.citation: J Occup Environ Med. 1998 Nov;40(11):958-63
references.pmid: 9830601
references.citation: Spine (Phila Pa 1976). 2004 May 1;29(9):1041-8
references.pmid: 15105679
references.citation: Spine (Phila Pa 1976). 1996 Dec 15;21(24):2820-5
references.pmid: 9112705
references.citation: J Health Econ. 2001 Jul;20(4):461-94
references.pmid: 11469231
references.citation: JAMA. 2003 Jun 4;289(21):2810-8
references.pmid: 12783911
references.citation: Annu Rev Public Health. 1999;20:125-44
references.pmid: 10352853
references.citation: J Health Soc Behav. 1995 Mar;36(1):1-10
references.pmid: 7738325
references.citation: Spine (Phila Pa 1976). 1983 Mar;8(2):141-4
references.pmid: 6222486
references.citation: Spine (Phila Pa 1976). 2002 Apr 15;27(8):864-70
references.pmid: 11935111
references.citation: BMC Musculoskelet Disord. 2004 May 24;5:14
references.pmid: 15157280
references.citation: J Am Coll Radiol. 2009 Jun;6(6):401-7
references.pmid: 19467485
references.citation: Health Technol Assess. 2004 May;8(17):iii, 1-131
references.pmid: 15130462
references.citation: Spine (Phila Pa 1976). 2012 Sep 1;37(19):1708-18
references.pmid: 22020590
references.citation: Radiology. 2004 May;231(2):343-51
references.pmid: 15031430
references.citation: J Occup Environ Med. 2000 Dec;42(12):1178-87
references.pmid: 11125681
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914
references.citation: J Health Econ. 2005 May;24(3):465-88
references.pmid: 15811539
references.citation: J Occup Environ Med. 2007 Jun;49(6):651-8
references.pmid: 17563608
references.citation: Spine J. 2011 Jul;11(7):622-32
references.pmid: 21601533
references.citation: Spine (Phila Pa 1976). 2003 May 15;28(10):1061-7; discussion 1067
references.pmid: 12768149
references.citation: Spine (Phila Pa 1976). 2008 Dec 1;33(25):2809-18
references.pmid: 19050587