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Choices and Consequences: An investigation into patient choice of provider and provider interventions for low back pain.

Bise, Christopher Gene (2021) Choices and Consequences: An investigation into patient choice of provider and provider interventions for low back pain. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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A significant portion of healthcare spending is for the treatment of low back pain (LBP). Treatment for low back pain is variable and interventions depend largely upon the provider. This dissertation sought to examine the influence of the first choice of provider, their choice of interventions and the trajectories of health care utilization and patient outcomes.
Using the database from a large insurer, we examined data for services billed from July 2015 through July 2018 and conducted a retrospective cohort analysis of patients seeking care for a new episode of LBP. We identified the first provider chosen and examined total medical utilization and LBP costs over the next year. 29,806 unique individuals were identified. Average total cost of care (TCOC) for all medical costs was lowest in those who first sought care with Chiropractic $7,761 (95% CI: $7,306, $8,218) or Physical Therapy $11,612 (95% CI: $10,586, $12,638). Highest average TCOC for all medical costs was seen in those who chose the Emergency Department, $20,028 (95% CI: $18,903, $21,154). There appears to be an association between the first choice of provider and future healthcare utilization.
Using the previously identified data, we narrowed our focus to those who chose the Emergency Department (ED) as the first choice of provider. The goal was to highlight the differences between guideline based and non-guideline based care. 2,895 individuals were analyzed. 1758 (61%) had at least one variable that met the definition of “non-concordant” care. 401 (14%) had 2 or more variables and 60 (2%) had all three variables. TCOC for all medical costs was lowest for concordant care, at an average of $18,839 (95% CI: $17,239, $20,385). Low back related spending per episode was also lowest for concordant care $2,635 (95% CI: $2,185, $3,084). There appears to be an association between the care delivered in the ED and future healthcare utilization.
Finally, we conducted a systematic review (PROSPERO-CRD42020212006) to investigate face-to-face telehealth evaluations or interventions for LBP. 5 studies met our inclusion criteria. The studies found reinforce the existing literature; PTs can perform comparable evaluations and interventions during in-person interactions and face-to-face telehealth environments.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Bise, Christopher Genecbise@pitt.educbise0000-0002-3714-5671
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSwitzer, Galen
Thesis AdvisorDelitto,
Committee MemberFreburger,
Committee MemberSchneider,
Committee MemberPeele,
Date: 20 May 2021
Date Type: Publication
Defense Date: 11 December 2020
Approval Date: 20 May 2021
Submission Date: 14 April 2021
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 129
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Clinical and Translational Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: low back pain, health services research, economic analyses, guideline based care, value based care
Date Deposited: 20 May 2021 14:29
Last Modified: 20 May 2021 14:29

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