Impact of co-morbidities on resource use and adherence to guidelines among commercially insured adults with new visits for back pain

Rationale, aims and objectivesTo assess if co-morbidity is associated with higher use of back-related care and adherence to back pain guidelines. MethodsWe conducted a retrospective cohort study using administrative claims data from 2007-2011. We included individuals 18 years with an index visit for back pain. Co-morbidities were measured 12 months prior to index. Co-morbidity burden was measured using Quan's Co-morbidity Index. Co-morbidities categories were measured using chronic condition indicators from the Agency for Healthcare Research and Quality. Total lumbar spine-related resource use for three years was ascertained using procedure codes. A clustering algorithm identified higher long-term utilizer. We identified initial use from day 0-42 for several categories of spine-related care. We used logistic regression to test the association between co-morbidities and resource use. ResultsGreater co-morbidity burden was associated with higher long-term spine-related resource use. Those with 2 on Quan's Co-morbidity Index had 29% higher odds of being a high back-specific resource user compared to those with no co-morbidities [Odds Ratio (OR): 1.29, 95% Confidence Interval (CI): 1.23-1.35]. Greater co-morbidity burden was associated with more frequent initial use of imaging, emergency visits, injections, and opioid fills; and less frequent initial use of medical and physical therapy visits. Co-morbid musculoskeletal conditions had the strongest association with being a high utilizer of long-term back-specific resources (OR: 1.53, 95% CI: 1.50-1.57). ConclusionsCo-morbidity burden and the presence of specific chronic conditions, such as musculoskeletal conditions, were associated with high long-term use of back-related care and care inconsistent with guidelines.