Geographic Variation in Spine Care Among Injured Workers.

摘要

This project addressed two National Occupational Research Agenda priority areas: occupational health services research and low back pain. Back pain among workers is an enormous medical, social, and economic burden in the United States. Back disorders account for 27% of all disabling occupational injuries in the United States and the average direct cost of a low back injury claim is more than twice that of other occupational injury claims combined. Surgical interventions are responsible for nearly one-third of the health care costs for workers with back injury. There is a lack of consensus among physicians, however, about the appropriate use of surgical interventions that result in large regional variations in care. The primary goal of the study was to examine community differences in the rate and types of spinal surgery performed on injured workers using small area analysis. Small area analysis is a commonly employed method in health services research but there have been limited applications of this technique in occupational health research. Oregon, as well as a number of neighboring Western states, has been identified as having elevated rates of spine surgery compared to the rest of the nation and significant local variation exists among communities based on prior analyses of Medicare claims data. The study was designed to evaluate whether a similar pattern of local variation existed for workers' compensation claims and to evaluate factors contributing to observed variations including physician specialty, physician supply, source of payment, and the effect of managed care. This project piloted the use of an existing state database of workers' compensation medical payments.