Geographic Variation in Diagnostic Ability and Quality of Care Metrics: A Case Study of Ankylosing Spondylitis and Low Back Pain. (16th May 2017)

• Record Type: Journal Article
• Authors: Shafrin, Jason; Griffith, Jenny; Shim, Jin Joo; Huber, Caroline; Ganguli, Arijit; Aubry, Wade
• Is Part Of: Inquiry. Volume 54(2017)
• Publication Date: 2017-05-16
• Subjects: back pain -- diagnosis -- health care costs; Medical policy -- United States -- Periodicals; Medical care, Cost of -- United States -- Periodicals; Hospitalization insurance -- United States -- Periodicals; 362.10973
• DOI: 10.1177/0046958017707873
• Languages: English
• ISSNs: 0046-9580

Abstract

Studies examining geographic variation in care for low back pain often focus on process and outcome measures conditional on patient diagnosis but generally do not take into account a physician's ability to diagnose the root cause of low back pain. In our case study, we used increased detection of ankylosing spondylitis—a relatively rare inflammatory back disease—as a proxy for diagnostic ability and measured the relationship between ankylosing spondylitis detection, potentially inappropriate low back pain care, and cost. Using 5 years of health insurance claims data, we found significant variation in ankylosing spondylitis detection across metropolitan statistical areas (MSAs), with 8.1% of the variation in detection explained by a region's racial composition. Furthermore, low back pain patients in MSAs with higher ankylosing spondylitis detection had 7.9% lower use of corticosteroids, 9.0% lower use of opioids, and 8.2% lower pharmacy cost, compared with patients living in low-detection MSAs.