Webster BS, et al.
Spine (Phila Pa 1976). 2014 May 14. [Epub ahead of print]
Abstract
Study Design. Retrospective cohort study.Objective. To compare type, timing, and longitudinal medical costs following adherent versus non-adherent magnetic resonance imaging (MRI) for work-related low back pain (LBP).Summary of Background Data. Guidelines advise against MRI for acute uncomplicated LBP, but is an option for persistent radicular pain after a trial of conservative care. Yet MRI has become frequent and often non-adherent. Few studies have documented the nature and impact of medical services (including type and timing) initiated by non-adherent MRI.Methods. A longitudinal, Workers Compensation administrative data source was accessed to select LBP claims filed between 01/01/06 – 12/31/06. Cases were grouped by MRI timing (Early, Timely, No MRI) and sub-grouped by severity (Less Severe, More Severe) (final cohort = 3,022). Healthcare utilization for each subgroup was evaluated at 3, 6, 9, and 12 months post-MRI. Multivariate logistic regression models examined risk of receiving subsequent diagnostic studies and/or treatments, adjusting for pain indicators and demographic covariates.Results. The adjusted relative risks for MRI group cases to receive electromyography, nerve conduction testing, advanced imaging, injections, and surgery within 6-months post-MRI ranged from 6.5 (95% CI: 2.20-19.09) to 54.9 (95% CI: 22.12 – 136.21) times the rate for the referent group (No MRI Less Severe). The Timely and Early MRI Less Severe subgroups had similar adjusted relative risks to receive most services. The Early MRI More Severe subgroup cases had generally higher adjusted relative risks than Timely MRI More Severe subgroup cases. Medical costs for both Early MRI subgroups were highest and increased the most over time.Conclusion. The impact of non-adherent MRI includes a wide variety of expensive and unnecessary services, and occurs relatively soon post-MRI. Study results provide evidence to promote provider and patient conversations to help patients choose care that is evidence-based, free from harm, less costly, and truly necessary.