--- title: "Health care utilization in low back pain. | Sutter Health" description: "LBP care use is variable, concentrated in small subgroups using disproportionate amts. of potentially avoidable care that reflect pt, provider characteristics." url: "https://www.sutterhealth.org/research/publications/health-care-utilization-in-low-back-pain-1055312713" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Health care utilization in low back pain. # Patterns of health care utilization for low back pain. Stewart WF, Yan X, Boscarino JA, Maeng DD, Mardekian J, Sanchez RJ, & Von Korff MR. _J Pain Res. 8:523-35. doi: 10.2147/JPR.S83599. eCollection 2015._ 2015-08-12 ## Abstract BACKGROUND: The purpose of this study was to determine if primary care patients with low back pain (LBP) cluster into definable care utilization subgroups that can be explained by patient and provider characteristics. MATERIALS AND METHODS: Adult primary care patients with an incident LBP encounter were identified from Geisinger Clinic electronic health records over 5 years. Two-thirds of the cohort had only one to two encounters. Principal component analysis was applied to the data from the remaining one-third on use of ambulatory, inpatient, emergency department, and surgery care and use of magnetic resonance imaging, injections, and opioids in 12 months following the incident encounter. Groups were compared on demographics, health behaviors, chronic and symptomatic disease burden, and a measure of physician efficiency. RESULTS: Six factors with eigenvalues >1.5 explained 71% of the utilization variance. Patient subgroups were defined as: 1-2 LBP encounters; 2+ surgeries; one surgery; specialty care without primary care; 3+ opioid prescriptions; laboratory dominant care; and others. The surgery and 3+ opioid subgroups, while accounting for only 10.4% of the cohort, had used disproportionately more magnetic resonance imaging, emergency department, inpatient, and injectable resources. The specialty care subgroup was characterized by heavy use of inpatient care and the lowest use of injectables. Anxiety disorder and depression were not more prevalent among the surgery patients than in the others. Surgery patients had features in common with specialty care patients, but were older, had higher prevalence of fibromyalgia, and were associated primary care physicians with worse efficiency scores. CONCLUSION: LBP care utilization is highly variable and concentrated in small subgroups using disproportionate amounts of potentially avoidable care that reflect both patient and provider characteristics. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/26316803) ![Xiaowei (Sherry) Yan, Ph.D.](https://dyn.mktgcdn.com/p/NTWox_hkmxIRiqJEc5PXKeBkfR_WMtpSQbEI4J69Xls/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Xiaowei (Sherry) Yan, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/xiaowei-sherry-yan-phd-1049681042) ## Research topics - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) - [Musculoskeletal Disorders](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Musculoskeletal+Disorders%5C%22%22) - [Pain](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Pain%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Patient characteristics and healthcare utilization of a chronic pain population within an integrated healthcare system.](https://www.sutterhealth.org/research/publications/pt-characteristics-healthcare-use-chronic-pain-1055312340) Romanelli RJ, Shah SN, Ikeda L, Lynch B, Craig TL, Cappelleri JC, Jukes T, Ishisaka D. Am J Manag Care. 23(2):e50-e56. 2017 Feb 01 - Publication ### [Opioid prescribing for chronic pain in a community-based healthcare system.](https://www.sutterhealth.org/research/publications/opiod-prescribing-chronic-pain-community-health-1055312298) Romanelli RJ, Ikeda LI, Lynch B, Craig T, Cappelleri JC, Jukes T, Ishisaka DY. Am J Manag Care. 23(5):e138-e145. 2017 May 01 - Publication ### [Implementation of patient-reported outcomes measurement information system data collection in a private orthopedic surgery practice.](https://www.sutterhealth.org/research/publications/implement-pt-reported-outcomes-system-orthopedic-practice-1055312399) Haskell A, Kim T. Foot Ankle Int. 1071100717753967. doi: 10.1177/1071100717753967. \[Epub ahead of print\] 2018 Jan 01 - Publication ### [Use of electronic health records for early detection of high-cost, low back pain patients.](https://www.sutterhealth.org/research/publications/use-ehrs-to-detect-high-cost-low-back-pain-pts-1055312584) Maeng DD, Stewart WF, Yan X, Boscarino JA, Mardekian J, Harnett J, Von Korff MR. Pain Res Manag. 20(5):234-40. Epub 2015 Aug 20. 2015 Sep 01 - Publication ### [Racial and ethnic disparities in opioid prescribing for long bone fractures at discharge from the emergency department: a cross-sectional analysis of 22 centers from a health care delivery system in Northern California.](https://www.sutterhealth.org/research/publications/racial-disparities-opiod-prescribing-for-fractures-in-ed-1055312717) Romanelli RJ, Shen Z, Szwerinski N, Scott A, Lockhart S, Pressman AR. Ann Emerg Med. pii: S0196-0644(19)30417-2. doi: 10.1016/j.annemergmed.2019.05.018. \[Epub ahead of print\] 2019 Jul 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/health-care-utilization-in-low-back-pain-1055312713#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Health care utilization in low back pain."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/health-care-utilization-in-low-back-pain-1055312713#medicalscholarlyarticle","name":"Patterns of health care utilization for low back pain.","headline":"Health care utilization in low back pain.","abstract":"BACKGROUND: The purpose of this study was to determine if primary care patients with low back pain (LBP) cluster into definable care utilization subgroups that can be explained by patient and provider characteristics. MATERIALS AND METHODS: Adult primary care patients with an incident LBP encounter were identified from Geisinger Clinic electronic health records over 5 years. Two-thirds of the cohort had only one to two encounters. Principal component analysis was applied to the data from the remaining one-third on use of ambulatory, inpatient, emergency department, and surgery care and use of magnetic resonance imaging, injections, and opioids in 12 months following the incident encounter. Groups were compared on demographics, health behaviors, chronic and symptomatic disease burden, and a measure of physician efficiency. RESULTS: Six factors with eigenvalues >1.5 explained 71% of the utilization variance. Patient subgroups were defined as: 1-2 LBP encounters; 2+ surgeries; one surgery; specialty care without primary care; 3+ opioid prescriptions; laboratory dominant care; and others. The surgery and 3+ opioid subgroups, while accounting for only 10.4% of the cohort, had used disproportionately more magnetic resonance imaging, emergency department, inpatient, and injectable resources. The specialty care subgroup was characterized by heavy use of inpatient care and the lowest use of injectables. Anxiety disorder and depression were not more prevalent among the surgery patients than in the others. Surgery patients had features in common with specialty care patients, but were older, had higher prevalence of fibromyalgia, and were associated primary care physicians with worse efficiency scores. CONCLUSION: LBP care utilization is highly variable and concentrated in small subgroups using disproportionate amounts of potentially avoidable care that reflect both patient and provider characteristics.","description":"LBP care use is variable, concentrated in small subgroups using disproportionate amts. of potentially avoidable care that reflect pt, provider characteristics.","keywords":["Health Services","Medical Informatics","Musculoskeletal Disorders","Pain"],"datePublished":"2015-08-12","url":"https://www.sutterhealth.org/research/publications/health-care-utilization-in-low-back-pain-1055312713","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"26316803"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.2147/JPR.S83599"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/26316803/","https://doi.org/10.2147/JPR.S83599"],"isPartOf":{"@type":"Periodical","name":"J Pain Res"},"author":[{"@type":"Person","name":"Stewart WF"},{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/xiaowei-sherry-yan-phd-1049681042","name":"Yan X","url":"https://www.sutterhealth.org/research/investigators/xiaowei-sherry-yan-phd-1049681042"},{"@type":"Person","name":"Boscarino JA"},{"@type":"Person","name":"Maeng DD"},{"@type":"Person","name":"Mardekian J"},{"@type":"Person","name":"Sanchez RJ"},{"@type":"Person","name":"Von Korff MR"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Health Services","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Services%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Musculoskeletal Disorders","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Musculoskeletal+Disorders%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Pain","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Pain%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/health-care-utilization-in-low-back-pain-1055312713","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/health-care-utilization-in-low-back-pain-1055312713#breadcrumblist"}}} ```