Less surgery and lower cost due to back pain in a care program with an interdisciplinary second opinion procedure : A controlled non-randomized intervention study based on claims data

Less surgery and lower cost due to back pain in a care program with an interdisciplinary second opinion procedure : A controlled non-randomized intervention study based on claims data

There is no evidence of effectiveness for interdisciplinary second opinion procedures (ISOP) for recommended back surgery (BS). Since 2015, AOK Nordost has been offering the care program RückenSPEZIAL comprising a preliminary examination, ISOP, and optional interdisciplinary multimodal pain therapy...

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Veröffentlicht in:Schmerz (Berlin, Germany) Germany), 2023-04, Vol.37 (2), p.123-133
Hauptverfasser: Wagner, Christoph J, Lindena, Gabriele, Ayyad, Grit, Otzdorff, Andrea, Marnitz, Ulf, Bienek, Karen, von Pickardt, Björn, Sehlen, Stephanie, Wyrwich, Werner
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Back Pain - therapy
Hospitalization
Humans
Referral and Consultation
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container_end_page 133
container_issue 2
container_start_page 123
container_title Schmerz (Berlin, Germany)
container_volume 37
creator Wagner, Christoph J
Lindena, Gabriele
Ayyad, Grit
Otzdorff, Andrea
Marnitz, Ulf
Bienek, Karen
von Pickardt, Björn
Sehlen, Stephanie
Wyrwich, Werner
description There is no evidence of effectiveness for interdisciplinary second opinion procedures (ISOP) for recommended back surgery (BS). Since 2015, AOK Nordost has been offering the care program RückenSPEZIAL comprising a preliminary examination, ISOP, and optional interdisciplinary multimodal pain therapy (IMPT). The objective of this study is to determine the effectiveness of RückenSPEZIAL to reduce BS and back pain-related costs (BPRC) compared to patients who likewise received a recommendation for back surgery but not RückenSPEZIAL. Insured persons in the AOK Nordost consulted the AOK service center, presented a BS hospital admission slip and received advice to participate in RückenSPEZIAL. Following a 1:1 "matched pairs" selection, patients who participated in RückenSPEZIAL (intervention group [IG]) after this consultation (reference date) where compared with patients who did not participate after this consultation (comparison group [CG]). Patient characteristics, BS and BPRC were operationalised from AOK Nordost claims data. Of 108 IG patients and 108 CG patients, 34 (42%) fewer IG patients had one or more BS in 365 following days (relative risk [RR] 0.58; p 
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Since 2015, AOK Nordost has been offering the care program RückenSPEZIAL comprising a preliminary examination, ISOP, and optional interdisciplinary multimodal pain therapy (IMPT). The objective of this study is to determine the effectiveness of RückenSPEZIAL to reduce BS and back pain-related costs (BPRC) compared to patients who likewise received a recommendation for back surgery but not RückenSPEZIAL. Insured persons in the AOK Nordost consulted the AOK service center, presented a BS hospital admission slip and received advice to participate in RückenSPEZIAL. Following a 1:1 "matched pairs" selection, patients who participated in RückenSPEZIAL (intervention group [IG]) after this consultation (reference date) where compared with patients who did not participate after this consultation (comparison group [CG]). Patient characteristics, BS and BPRC were operationalised from AOK Nordost claims data. Of 108 IG patients and 108 CG patients, 34 (42%) fewer IG patients had one or more BS in 365 following days (relative risk [RR] 0.58; p &lt; 0.001). The subgroup analysis showed for 21 IG patients with ISOP and IMPT an RR of 0.13 (p &lt; 0.001), and for 67 IG patients with solely ISOP without IMPT an RR of 0.59 (p &lt; 0.001). The increase in RBC from the previous year to the following year was 50.2 percentage points lower for IG patients compared to CG patients (p = 0.088). The differences in BS were significant (p &lt; 0.05) and in favor of RückenSPEZIAL. For the specific population it can be expected that mainly savings on BS can cover the intervention costs of RückenSPEZIAL (approximately significant, small case number). 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Of 108 IG patients and 108 CG patients, 34 (42%) fewer IG patients had one or more BS in 365 following days (relative risk [RR] 0.58; p &lt; 0.001). The subgroup analysis showed for 21 IG patients with ISOP and IMPT an RR of 0.13 (p &lt; 0.001), and for 67 IG patients with solely ISOP without IMPT an RR of 0.59 (p &lt; 0.001). The increase in RBC from the previous year to the following year was 50.2 percentage points lower for IG patients compared to CG patients (p = 0.088). The differences in BS were significant (p &lt; 0.05) and in favor of RückenSPEZIAL. For the specific population it can be expected that mainly savings on BS can cover the intervention costs of RückenSPEZIAL (approximately significant, small case number). Bias due to self-selection needs to be assumed.</abstract><cop>Germany</cop><pmid>35192050</pmid><doi>10.1007/s00482-022-00624-2</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record>
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subjects Back Pain - therapy
Hospitalization
Humans
Referral and Consultation
title Less surgery and lower cost due to back pain in a care program with an interdisciplinary second opinion procedure : A controlled non-randomized intervention study based on claims data
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