The cascade of medical services and associated longitudinal costs due to nonadherent magnetic resonance imaging for low back pain.
METHODS
Retrospective cohort study.


OBJECTIVE
To compare type, timing, and longitudinal medical costs incurred after adherent versus nonadherent magnetic resonance imaging (MRI) for work-related low back pain.


BACKGROUND
Guidelines advise against MRI for acute uncomplicated low back pain, but is an option for persistent radicular pain after a trial of conservative care. Yet, MRI has become frequent and often nonadherent. Few studies have documented the nature and impact of medical services (including type and timing) initiated by nonadherent MRI.


METHODS
A longitudinal, workers' compensation administrative data source was accessed to select low back pain claims filed between January 1, 2006 and December 31, 2006. Cases were grouped by MRI timing (early, timely, no MRI) and subgrouped by severity ("less severe," "more severe") (final cohort = 3022). Health care utilization for each subgroup was evaluated at 3, 6, 9, and 12 months post-MRI. Multivariate logistic regression models examined risk of receiving subsequent diagnostic studies and/or treatments, adjusting for pain indicators and demographic covariates.


RESULTS
The adjusted relative risks for MRI group cases to receive electromyography, nerve conduction testing, advanced imaging, injections, and surgery within 6 months post-MRI risks in the range from 6.5 (95% CI: 2.20-19.09) to 54.9 (95% CI: 22.12-136.21) times the rate for the referent group (no MRI less severe). The timely and early MRI less severe subgroups had similar adjusted relative risks to receive most services. The early MRI more severe subgroup cases had generally higher adjusted relative risks than timely MRI more severe subgroup cases. Medical costs for both early MRI subgroups were highest and increased the most over time.


CONCLUSIONS
The impact of nonadherent MRI includes a wide variety of expensive and potentially unnecessary services, and occurs relatively soon post-MRI. Study results provide evidence to promote provider and patient conversations to help patients choose care that is based on evidence, free from harm, less costly, and truly necessary.


METHODS
N/A.
*Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA †Major Accounts Division, Helmsman Management Services LLC, Liberty Mutual Insurance, Boston, MA; and ‡University of Massachusetts-Lowell, Lowell, MA.
Barbara S
BS
Webster
YoonSun
Y
Choi
Ann Z
AZ
Bauer
Manuel
M
Cifuentes
Glenn
G
Pransky
D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000175:diagnosis* / Q000191:economics; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis*; D012189:Retrospective Studies; D014942:Workers' Compensation / Q000191:economics