Associations between utilization rates and patients' health: a study of spine surgery and patient-reported outcomes (EQ-5D and ODI).

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Patient Reported Outcome Measures*; Lumbar Vertebrae/*surgery ; Patient Acceptance of Health Care/*statistics & numerical data ; Spinal Diseases/*surgery; Female ; Humans ; Male ; Middle Aged ; Norway ; Quality of Life ; Registries ; Treatment Outcome

Background: A vast body of literature has documented regional variations in healthcare utilization rates. The extent to which such variations are "unwarranted" critically depends on whether there are corresponding variations in patients' needs. Using a unique medical registry, the current paper investigated any associations between utilization rates and patients' needs, as measured by two patient-reported outcome measures (PROMs).
Methods: This observational panel study merged patient-level data from the Norwegian Patient Registry (NPR), Statistics Norway, and the Norwegian Registry for Spine Surgery (NORspine) for individuals who received surgery for degenerative lumbar spine disorders in 2010-2015. NPR consists of hospital administration data. NORspine includes two PROMs: the generic health-related quality of life instrument EQ-5D and the disease-specific, health-related quality of life instrument Oswestry Disability Index (ODI). Measurements were assessed at baseline and at 3 and 12 months post-surgery and included a wide range of patient characteristics. Our case sample included 15,810 individuals. We analyzed all data using generalized estimating equations.
Results: Our results show that as treatment rates increase, patients have better health at baseline. Furthermore, increased treatment rates are associated with smaller health gain.
Conclusion: The correlation between treatment rates and patients health indicate the presence of unwarranted variation in treatment rates for lumbar spine disorders.

Biometrics. 1986 Mar;42(1):121-30. (PMID: 3719049)
Surgery. 1998 Nov;124(5):917-23. (PMID: 9823407)
Stat Med. 2000 May 30;19(10):1265-75. (PMID: 10814976)
J Neurosurg Spine. 2014 Jan;20(1):83-6. (PMID: 24206036)
Value Health. 2018 Apr;21(4):375-379. (PMID: 29680091)
Health Policy. 2014 Jan;114(1):5-14. (PMID: 24054709)
N Engl J Med. 1978 Jun 1;298(22):1229-38. (PMID: 418336)
Tidsskr Nor Laegeforen. 2010 Dec 2;130(23):2369-70. (PMID: 21139664)
Am Econ J Appl Econ. 2011 Jul;3(3):221-243. (PMID: 23853699)
Lancet. 2017 Jul 8;390(10090):156-168. (PMID: 28077234)
BMJ. 2002 Oct 26;325(7370):961-4. (PMID: 12399352)
J Bone Joint Surg Am. 1999 Jun;81(6):752-62. (PMID: 10391540)
Med Care. 1997 Nov;35(11):1095-108. (PMID: 9366889)
BMC Health Serv Res. 2018 Jun 4;18(1):403. (PMID: 29866201)
Acta Orthop. 2011 Feb;82(1):56-63. (PMID: 21189113)
Ann Intern Med. 2003 Feb 18;138(4):288-98. (PMID: 12585826)
Health Serv Res. 2000 Feb;34(6):1351-62. (PMID: 10654835)
BMJ Open. 2018 Jun 15;8(6):e021199. (PMID: 29909370)
Lancet. 2013 Sep 28;382(9898):1121-9. (PMID: 24075052)
Spine (Phila Pa 1976). 2011 Nov 15;36(24):2061-8. (PMID: 22048651)
J Eval Clin Pract. 2013 Dec;19(6):1054-9. (PMID: 23520992)
Acta Radiol. 2019 Sep;60(9):1153-1158. (PMID: 30417668)
Med Care. 2015 Apr;53(4):310-6. (PMID: 25654295)
Am Econ J Econ Policy. 2018 Feb;10(1):326-356. (PMID: 29607002)

Keywords: Baseline health; EQ-5D; Flat of the curve; Health gain; ODI; Regional variation

Date Created: 20200224 Date Completed: 20200625 Latest Revision: 20200625

20240513

PMC7036171

10.1186/s12913-020-4968-2

32087710