Longitudinal Care Patterns and Utilization
Among Patients with New-Onset Neck Pain
by Initial Provider Specialty

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:     Frankp@chiro.org

FROM:   Spine (Phila Pa 1976) 2023 (Aug 1) [EPUB] ~ FULL TEXT

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Joshua J. Fenton, MD, MPH; Shao-You Fang, PhD; Monika Ray, PhD; John Kennedy, CCS, CDIP; Katrine Padilla, MPP; Russell Amundson, MD, FAANS; David Elton, DC; Scott Haldeman, DC, MD, PhD, FRCP(C); Anthony Lisi, DC; Jason Sico, MD, MHS, FAHA, FAAN, FACP, FANA; Peter M Wayne, PhD; Patrick S Romano, MD, MPH, FAAP, FACP

Department of Family and Community Medicine,
University of California, Davis,
Sacramento CA

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FROM:   BMJ Open. 2019 (Sep 20)

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Study design:   Retrospective cohort study.

Objective:   To compare utilization patterns for patients with new-onset neck pain by initial provider specialty.

Summary of background data:   Initial provider specialty has been associated with distinct care patterns among patients with acute back pain; little is known about care patterns among patients with acute neck pain.

Methods:   Deidentified administrative claims and electronic health record (EHR) data derived from the Optum Labs Data Warehouse, which contains longitudinal health information on over 200M enrollees and patients, representing a mixture of ages and geographical regions across the U.S. Patients had outpatient visits for new-onset neck pain from October 1, 2016 to September 30, 2019, classified by initial provider specialty. Utilization was assessed during a 180-day follow-up period, including subsequent neck pain visits, diagnostic imaging, and therapeutic interventions.

Results:   The cohort included 770,326 patients with new-onset neck pain visits. The most common initial provider specialty was chiropractor (45.2%), followed by primary care (33.4%). Initial provider specialty was strongly associated with the receipt of subsequent neck pain visits with the same provider specialty. Rates and types of diagnostic imaging and therapeutic interventions during follow-up also varied widely by initial provider specialty. While uncommon after initial visits with chiropractors (≤2%), CT or MRI scans occurred in over 30% of patients with initial visits with emergency physicians, orthopedists, or neurologists. Similarly, 6.8% and 3.4% of patients initially seen by orthopedists received therapeutic injection and major surgery, respectively, as compared to 0.4% and 0.1% of patients initially seen by a chiropractor.

Conclusion:   Within a large, national cohort, chiropractors were the initial provider for a plurality of patients with new-onset neck pain. Compared to patients initially seen by physician providers, patients with chiropractor initial providers received fewer and less costly imaging services and were less likely to receive invasive therapeutic interventions during follow-up.

Level of evidence:   Level 3 (non-randomized controlled cohort study).

Keywords:   Neck Pain, Cervicalgia, Healthcare Utilization, Provider Specialty, Chiropractic Care, Physical Therapy, Occupational Therapy

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