Spine 2012
May 1;37(10):860-74.
Title:
Identifying neck and back pain in administrative data: defining the right
cohort
Authors
Sinnott PL
Siroka AM
Shane AC
Trafton JA
Wagner TH
Study Design.
1.
Reviewed existing methods for identifying patients
with neck and back pain
in administrative data.
2.
Compared these methods using data from the Department of Veterans Affairs.
Objective
To
answer the following questions:
(1)
What diagnosis codes should be used to identify patients with neck pain and back pain in administrative data?
(2)
Because the majority of complaints are characterized as nonspecific or
mechanical, what diagnosis codes should be used to identify patients with
nonspecific or mechanical problems in administrative data?
(3)
What procedure and surgical codes should be used to identify patients who have
undergone a surgical procedure on the neck or back?
Summary of Background Data
1.
Musculoskeletal neck and
back pain are pervasive problems, associated with chronic pain, disability, and high rates of health care
utilization.
2.
Administrative data have been widely used in formative research, which has
largely relied on the original work of Volinn, Cherkin, Deyo, and Einstadter
and the Back Pain Patient Outcomes Assessment Team
first published in 1992.
3.
Significant variation in reports of incidence, prevalence, and morbidity
associated with these problems may be due to nonstandard or conflicting methods
to define study cohorts.
Methods
1.
7 methods for identifying neck
and back pain in administrative data
1)
Small area analysis of surgery for low back pain (Spine 1992;17:575–81)
2)
Use of the International Classification of Diseases ( ICD-9-CM ) to identify hospitalizations for mechanical low back
problems in administrative databases (Spine 1992;17:817–25)
3)
Variation in the rate of cervical spine surgery in Washington State (Med Care 1993;31:711–18)
4)
Hospitalizations for back and neck problems: a comparison between the Province of
Ontario and Washington State (Health Serv Res 1998;33( Pt 1):929–45)
5)
National and regional rates and variation of cervical discectomy with and
without anterior fusion, 1990-1999 (Spine 2003;28:931–9;discussion 940)
6)
Expenditures and health status among adults with back and neck problems (JAMA 2008;299:656–64)
7) Clinical Classifications
Software (CCS) 2009. Available at: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp.
Published 2009. Accessed September 23, 2009. And Clinical
Classifications for Health Policy Research: Discharge Statistics by Principal
Diagnosis and Procedure. ockville, MD: Agency
for Health Care Policy and Research;1993
2.
These code lists were used to search Veterans Health Administration data for
patients with back and neck
problems, and to further categorize each case by spinal segment involved, as
nonspecific/mechanical and as surgical or not.
Results
There
is considerable overlap in most algorithms. However, gaps persist.
Conclusion
Gaps are evident
in existing methods and a new framework to identify patients with neck pain and back pain in administrative data is proposed.
Key points
1.
Methods for identifying patients with neck and back problems in administrative
data have not kept pace with changes in practice and coding
2.
A review of current methods suggests a new frame work for identifying patients
with neck and back pain in administrative data.
3.
An updated framework to identify patients with neck and back pain in
administrative data will help capture more case for analyses.
"This comes
from Spine (c) 2012 Lippincott Williams & Wilkins, Inc."
Autumn and Raining |
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