--- title: "Use EHRs to detect high-cost, low back pain pts. | Sutter Health" description: "Results suggest that it is feasible to develop a dynamic, PCP visit-based predictive model for LBP care based on longitudinal data obtained in EHRs." url: "https://www.sutterhealth.org/research/publications/use-ehrs-to-detect-high-cost-low-back-pain-pts-1055312584" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Use EHRs to detect high-cost, low back pain pts. # Use of electronic health records for early detection of high-cost, low back pain patients. 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._ 2015-09-01 ## Abstract BACKGROUND: Low back pain (LBP) is a debilitating condition that is complex to manage. One reason is that clinicians lack means to identify early on patients who are likely to become high care utilizers. OBJECTIVE: To explore the feasibility of developing a 'dynamic' predictive model using electronic health record data to identify costly LBP patients within the first year after their initial LBP encounter with a primary care provider. Dynamic, in this context, indicates a process in which the decision on how to manage patients is dependent on whether they are at their first, second or third LBP visit with the provider. METHODS: A series of logistic regression models was developed to predict who will be a high-cost patient (defined as top 30% of the cost distribution) at each of the first three LBP visits. RESULTS: The c-statistics of the three logistic regression models corresponding to each of the first three visits were 0.683, 0.795 and 0.741, respectively. The overall sensitivity of the model was 42%, the specificity was 86% and the positive predictive value was 48%. Men were more likely to become expensive than women, while patients who had workers' compensation as their primary payer type had higher use of prescription opioid drugs or were smokers before the first LBP visit were also more likely to become expensive. CONCLUSION: The results suggest that it is feasible to develop a dynamic, primary care provider visit-based predictive model for LBP care based on longitudinal data obtained via electronic health records. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/26291127) ![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 - [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 ### [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 - Publication ### [Patterns of health care utilization for low back pain.](https://www.sutterhealth.org/research/publications/health-care-utilization-in-low-back-pain-1055312713) 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 Aug 12 - 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 [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/use-ehrs-to-detect-high-cost-low-back-pain-pts-1055312584#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":"Use EHRs to detect high-cost, low back pain pts."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/use-ehrs-to-detect-high-cost-low-back-pain-pts-1055312584#medicalscholarlyarticle","name":"Use of electronic health records for early detection of high-cost, low back pain patients.","headline":"Use EHRs to detect high-cost, low back pain pts.","abstract":"BACKGROUND: Low back pain (LBP) is a debilitating condition that is complex to manage. One reason is that clinicians lack means to identify early on patients who are likely to become high care utilizers. OBJECTIVE: To explore the feasibility of developing a 'dynamic' predictive model using electronic health record data to identify costly LBP patients within the first year after their initial LBP encounter with a primary care provider. Dynamic, in this context, indicates a process in which the decision on how to manage patients is dependent on whether they are at their first, second or third LBP visit with the provider. METHODS: A series of logistic regression models was developed to predict who will be a high-cost patient (defined as top 30% of the cost distribution) at each of the first three LBP visits. RESULTS: The c-statistics of the three logistic regression models corresponding to each of the first three visits were 0.683, 0.795 and 0.741, respectively. The overall sensitivity of the model was 42%, the specificity was 86% and the positive predictive value was 48%. Men were more likely to become expensive than women, while patients who had workers' compensation as their primary payer type had higher use of prescription opioid drugs or were smokers before the first LBP visit were also more likely to become expensive. CONCLUSION: The results suggest that it is feasible to develop a dynamic, primary care provider visit-based predictive model for LBP care based on longitudinal data obtained via electronic health records.","description":"Results suggest that it is feasible to develop a dynamic, PCP visit-based predictive model for LBP care based on longitudinal data obtained in EHRs.","keywords":["Medical Informatics","Musculoskeletal Disorders","Pain"],"datePublished":"2015-09-01","url":"https://www.sutterhealth.org/research/publications/use-ehrs-to-detect-high-cost-low-back-pain-pts-1055312584","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"26291127"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/26291127/"],"isPartOf":{"@type":"Periodical","name":"Pain Res Manag"},"author":[{"@type":"Person","name":"Maeng DD"},{"@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":"Mardekian J"},{"@type":"Person","name":"Harnett J"},{"@type":"Person","name":"Von Korff MR"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@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/use-ehrs-to-detect-high-cost-low-back-pain-pts-1055312584","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/use-ehrs-to-detect-high-cost-low-back-pain-pts-1055312584#breadcrumblist"}}} ```