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BMC Health Serv Res. 2018 Aug 20;18(1):648. doi: 10.1186/s12913-018-3470-6.

Prediction of healthcare utilization following an episode of physical therapy for musculoskeletal pain.

Author information

1
Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC, 27705, USA. trevor.lentz@duke.edu.
2
Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA.
3
Brooks Rehabilitation Clinical Research Center, 3901 University Blvd. South, Suite 103, Jacksonville, FL, 32216, USA.
4
Duke Clinical Research Institute, Department of Orthopaedic Surgery, Duke University, 2400 Pratt Street, Durham, NC, 27705, USA.

Abstract

BACKGROUND:

In the United States, value-based purchasing has created the need for healthcare systems to prospectively identify patients at risk for high healthcare utilization beyond a physical therapy episode for musculoskeletal pain. The purpose of this study was to determine predictors of pain-related healthcare utilization subsequent to an index episode of physical therapy for musculoskeletal pain.

METHODS:

This study assessed data from the Optimal Screening for Prediction of Referral and Outcome (OSPRO) longitudinal cohort study that recruited individuals with a primary complaint of neck, low back, knee or shoulder pain in physical therapy (n = 440). Demographics, health-related information, review of systems, comorbidity and pain-related psychological distress measures were collected at baseline evaluation. Baseline to 4-week changes in pain intensity, disability, and pain-related psychological distress were measured as treatment response variables. At 6-months and 1-year after baseline evaluation, individuals reported use of opioids, injection, surgery, diagnostic tests or imaging, and emergency room visits for their pain condition over the follow-up period. Separate prediction models were developed for any subsequent care and service-specific utilization.

RESULTS:

Subsequent pain-related healthcare utilization was reported by 43% (n = 106) of the study sample that completed the 12-month follow-up (n = 246). Baseline disability and 4-week change in pain intensity were important global predictors of subsequent healthcare utilization. Age, insurance status, comorbidity burden, baseline pain, and 4-week changes in pain intensity, disability and pain-related psychological distress predicted specific service utilization.

CONCLUSION:

In those completing follow up measures, risk of additional pain-related healthcare utilization after physical therapy was best predicted by baseline characteristics and 4-week treatment response variables for pain intensity, disability and pain-related psychological distress. These findings suggest treatment monitoring of specific response variables could enhance identification of those at risk for future healthcare utilization in addition to baseline assessment. Further study is required to determine how specific characteristics of the clinical encounter influence future utilization.

KEYWORDS:

Multimorbidity; Psychological distress; Screening; Treatment monitoring; Value

PMID:
30126409
PMCID:
PMC6102917
DOI:
10.1186/s12913-018-3470-6
[Indexed for MEDLINE]
Free PMC Article

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