title: Evaluating increased resource use in fibromyalgia using electronic health records.
abstract: OBJECTIVE
  The management of fibromyalgia (FM), a chronic musculoskeletal disease, remains challenging, and patients with FM are often characterized by high health care resource utilization. This study sought to explore potential drivers of all-cause health care resource utilization and other factors associated with high resource use, using a large electronic health records (EHR) database to explore data from patients diagnosed with FM.
  
  
  METHODS
  This was a retrospective analysis of de-identified EHR data from the Humedica database. Adults (≥18 years) with FM were identified based on ≥2 International Classification of Diseases, Ninth Revision codes for FM (729.1) ≥30 days apart between January 1, 2008 and December 31, 2012 and were required to have evidence of ≥12 months continuous care pre- and post-index; first FM diagnosis was the index event; 12-month pre- and post-index reporting periods. Multivariable analysis evaluated relationships between variables and resource utilization.
  
  
  RESULTS
  Patients were predominantly female (81.4%), Caucasian (87.7%), with a mean (standard deviation) age of 54.4 (14.8) years. The highest health care resource utilization was observed for the categories of "medication orders" and "physician office visits," with 12-month post-index means of 21.2 (21.5) drug orders/patient and 15.1 (18.1) office visits/patient; the latter accounted for 73.3% of all health care visits. Opioids were the most common prescription medication, 44.3% of all patients. The chance of high resource use was significantly increased (P<0.001) 26% among African-Americans vs Caucasians and for patients with specific comorbid conditions ranging from 6% (musculoskeletal pain or depression/bipolar disorder) to 21% (congestive heart failure). Factors significantly associated with increased medications ordered included being female (P<0.001) and specific comorbid conditions (P<0.05).
  
  
  CONCLUSIONS
  Physician office visits and pharmacotherapy orders were key drivers of all-cause health care utilization, with demographic factors, opioid use, and specific comorbidities associated with resource intensity. Health systems and providers may find their EHRs to be a useful tool for identifying and managing resource-intensive FM patients.
authors.affiliation: Truven Health Analytics, Life Sciences, Outcomes Research, Bethesda, MD.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Margolis
authors.affiliation: Pfizer Inc, Outcomes & Evidence, New York, NY.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Masters
authors.affiliation: Pfizer Inc, Statistics, Groton, CT.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cappelleri
authors.affiliation: Truven Health Analytics, Life Sciences, Outcomes Research, Bethesda, MD.
authors.forename: David M
authors.initials: DM
authors.lastname: Smith
authors.affiliation: Pfizer Inc, North American Medical Affairs, Medical Outcomes Specialists, St Louis, MO, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Faulkner
keywords: electronic health records; fibromyalgia; health care resource utilization