Y Raja Rampersaud1, J Denise Power2, Anthony V Perruccio3, J Michael Paterson4, Christian Veillette5, Peter C Coyte6, Elizabeth M Badley7, Nizar N Mahomed5. 1. Arthritis Program, Krembil Research Institute, University Health Network, 60 Leonard Ave, Toronto, ON M5T 0S8 Canada; Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, ON M5T 1P5, Canada. Electronic address: raja.rampersaud@uhn.ca. 2. Arthritis Program, Krembil Research Institute, University Health Network, 60 Leonard Ave, Toronto, ON M5T 0S8 Canada. 3. Arthritis Program, Krembil Research Institute, University Health Network, 60 Leonard Ave, Toronto, ON M5T 0S8 Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada. 4. Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; ICES, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada. 5. Arthritis Program, Krembil Research Institute, University Health Network, 60 Leonard Ave, Toronto, ON M5T 0S8 Canada; Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, ON M5T 1P5, Canada. 6. Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada. 7. Arthritis Program, Krembil Research Institute, University Health Network, 60 Leonard Ave, Toronto, ON M5T 0S8 Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON M5T 3M7, Canada.
Abstract
BACKGROUND CONTEXT: An important step in improving spinal care is understanding how current health-care resources and associated cost are being utilized and distributed across a health-care system. PURPOSE: Our objective was to examine the magnitude and distribution of direct health care costs for spinal conditions across physician type and hospital setting. DESIGN/ SETTING: Cross-sectional analysis of administrative health data for the fiscal year 2013-2014 from the province of Ontario, Canada. PATIENT SAMPLE: Adult population aged 18+ years (N=10,841,302). OUTCOME MEASURES: Person visit rates and total number of people and visits by specific care settings were calculated for all spinal conditions as well as stratified by nontrauma and trauma-related conditions. Variation in rates by age and sex was examined. The proportion of patients seeing physicians of different specialties was calculated for each condition grouping. Direct medical costs were estimated and their percentage distribution by care setting calculated for nontrauma and trauma-related conditions. Additionally, costs for spinal imaging overall and stratified by type of scan were determined. METHODS: Administrative health databases were analyzed, including data on physician services, emergency department visits, and hospitalizations. ICD-9 and -10 diagnostic codes were used to identify nontraumatic (degenerative or inflammatory) and traumatic spinal disorders. A validated algorithm was used to estimate direct medical costs. RESULTS: Overall, 822,000 adult Ontarians (7.6%) made 1.6 million outpatient physician visits for spinal conditions; the majority (1.1 million) of these visits were for nontrauma conditions. Approximately, 86% of outpatient visits were in primary care. Emergency Department (ED) visits for nontrauma spinal conditions (130,000 out of 156,000 ED visits) accounted for 2.8% of all ED visits in the province. Total costs for spine-related care were $264 million (CDN) with 64% of costs due to nontrauma conditions. For these nontrauma conditions, ED visits cost $28 million for 130,000 visits ($215 per visit). For $32 million spent in primary care, 890,000 visits were made ($36 per visit). Spine imaging costs were $66.5 million, yielding a combined total of $330 million in health care spending for spinal conditions. CONCLUSIONS: Spinal conditions place a large and costly burden on the health-care system. The disproportionate annual cost associated with ED visits represents a potential opportunity to redirect costs to fund more clinically and cost-effective models of care for nontraumatic spinal conditions.
BACKGROUND CONTEXT: An important step in improving spinal care is understanding how current health-care resources and associated cost are being utilized and distributed across a health-care system. PURPOSE: Our objective was to examine the magnitude and distribution of direct health care costs for spinal conditions across physician type and hospital setting. DESIGN/ SETTING: Cross-sectional analysis of administrative health data for the fiscal year 2013-2014 from the province of Ontario, Canada. PATIENT SAMPLE: Adult population aged 18+ years (N=10,841,302). OUTCOME MEASURES: Person visit rates and total number of people and visits by specific care settings were calculated for all spinal conditions as well as stratified by nontrauma and trauma-related conditions. Variation in rates by age and sex was examined. The proportion of patients seeing physicians of different specialties was calculated for each condition grouping. Direct medical costs were estimated and their percentage distribution by care setting calculated for nontrauma and trauma-related conditions. Additionally, costs for spinal imaging overall and stratified by type of scan were determined. METHODS: Administrative health databases were analyzed, including data on physician services, emergency department visits, and hospitalizations. ICD-9 and -10 diagnostic codes were used to identify nontraumatic (degenerative or inflammatory) and traumatic spinal disorders. A validated algorithm was used to estimate direct medical costs. RESULTS: Overall, 822,000 adult Ontarians (7.6%) made 1.6 million outpatient physician visits for spinal conditions; the majority (1.1 million) of these visits were for nontrauma conditions. Approximately, 86% of outpatient visits were in primary care. Emergency Department (ED) visits for nontrauma spinal conditions (130,000 out of 156,000 ED visits) accounted for 2.8% of all ED visits in the province. Total costs for spine-related care were $264 million (CDN) with 64% of costs due to nontrauma conditions. For these nontrauma conditions, ED visits cost $28 million for 130,000 visits ($215 per visit). For $32 million spent in primary care, 890,000 visits were made ($36 per visit). Spine imaging costs were $66.5 million, yielding a combined total of $330 million in health care spending for spinal conditions. CONCLUSIONS: Spinal conditions place a large and costly burden on the health-care system. The disproportionate annual cost associated with ED visits represents a potential opportunity to redirect costs to fund more clinically and cost-effective models of care for nontraumatic spinal conditions.
Authors: Jacek A Kopec; Eric C Sayre; Jolanda Cibere; Linda C Li; Hubert Wong; Anya Okhmatovskaia; John M Esdaile Journal: BMC Musculoskelet Disord Date: 2022-08-23 Impact factor: 2.562
Authors: Danielle M Coombs; Gustavo C Machado; Bethan Richards; Ross Wilson; Jimmy Chan; Hannah Storey; Chris G Maher Journal: Lancet Reg Health West Pac Date: 2021-01-29