Health Care Utilization After Interdisciplinary Chronic Pain Treatment: Part I. Description of Utilization of Costly Health Care Interventions

摘要

Chronic musculoskeletal pain (CMP) is a significant burden for chronic pain sufferers, their medical and allied health treatment providers, and the U.S. medical system. The U.S. military has seen a significant increase in CMP with increased injuries stemming from military operations in Iraq and Afghanistan, and advances in care for CMP are sorely needed. Poor chronic pain treatment in the military has led to high levels of costly health care utilization with related costs estimated in billions of dollars. The functional occupational restoration treatment (FORT) trial, funded by the Congressionally Directed Medical Research Programs (Department of Defense), was the first formal, randomized trial of a novel interdisciplinary management program for CMP among active duty service members. Excellent clinical outcomes at posttreatment and long-term follow-up have been reported elsewhere. This paper examined patterns of health care utilization among FORT study participants for a period of 1 year before and after the study intervention or yoked, 3-week control period. We examined the military's Armed Forces Health Longitudinal Technology Application, which went online in 2004, to identify costly health visits and procedures consumed by study completers. We then compared utilization rates between those who received the interdisciplinary FORT treatment and those who were randomized to treatment as usual. Our analyses revealed significant between-group differences at posttreatment (controlling for pretreatment intervention use), with FORT participants receiving significantly fewer procedures including emergency department intervention, injections, and radio frequency nerve ablations. This paper precedes a follow-up study of mediating factors for health care utilization after interdisciplinary treatment.