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.

Graves Janessa M JM, Fulton-Kehoe Deborah D, Jarvik Jeffrey G JG, Franklin Gary M GM

PubMedClinical StudyReal-world Evidence




Published:2014 Apr

Created at:

Last revised:2017-02-20

Source:Health services research (Health Serv Res), volume 49, issue 2, 2014, ISSN: 1475-6773

Publication Country:United States

Publication Type:Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov’t, Research Support, U.S. Gov’t, P.H.S.

Keywords:Low back pain, clinical practice guidelines, costs, diagnostic imaging, utilization, workers’ compensation

MeSH Terms:Acute Disease; Adult; Female; Guideline Adherence (statistics & numerical data); Health Expenditures; Health Services (economics, utilization); Humans; Insurance Claim Review (statistics & numerical data); Low Back Pain (diagnosis); Magnetic Resonance Imaging; Male; Middle Aged; Occupational Diseases (diagnosis); Practice Guidelines as Topic; Socioeconomic Factors; Washington (epidemiology); Workers’ Compensation


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).

DATA SOURCESWashington State Disability Risk Identification Study Cohort (D-RISC), consisting of administrative claims and patient interview data from workers’ compensation claimants (2002-2004).

STUDY DESIGN: In this prospective, populationbased 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).

DATA COLLECTION/EXTRACTION 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.

PRINCIPAL FINDINGS: 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 guidelineadherent imaging; utilization of chiropractic care was significantly lower (18 percent).

CONCLUSIONSNonadherence 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.

© Health Research and Educational Trust.





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