2012년 11월 5일 월요일

Identifying neck and back pain in administrative data: defining the right cohort (Spine 2012 May 1;37(10):860-74)


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.


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