Non-Pharmacological Therapies vs. Prescription Drug Therapy for Care of Aged Medicare Beneficiaries with Spinal Pain

About This Grant

PROJECT SUMMARY Spinal Pain (SP) is highly prevalent, costly, and a leading cause of disability, but the management of SP in the United States tends to be inefficient, costly, and sometimes hazardous. Thus, there is an acute need to identify safe, high-quality management strategies for patients with SP. Because SP is often persistent, many patients feel compelled to seek ongoing care, but the chronic use of PDT (primarily opioids and NSAIDs) for SP raises safety concerns. Because the prevalence of SP increases with age, the need for high-quality spine care is critical for older adults with NP, who tend to be comorbid, vulnerable to adverse events, and prone to the utilization of high-cost interventions. Prescription drug therapy (PDT) and non-pharmacological therapies (NPT) which have been shown to offer similar effectiveness in systematic reviews, are widely used treatment strategies for SP, but their comparative quality and value for older adults with SP is uncertain. There is, therefore, a pressing need to compare these two general approaches (NPT and PDT) for management of SP in Medicare beneficiaries. The overall objective of this project is to assess the quality and value of NPT as compared to PDT for management of SP in Medicare beneficiaries aged 65 years and older. With active engagement of students, this project will strengthen the research environment at Southern California University of Health Sciences. The central research question is whether Medicare Fee for Service (FFS) beneficiaries aged 65+ with SP receive superior healthcare quality with NPT, PDT or both. The central question will be answered through analysis of Medicare administrative and claims data to: (1) compare the safety of care for recipients of NPT to PDT and combined NPT+PDT as measured by the likelihood of adverse outcomes, (2) compare the efficiency of care for recipients of NPT to PDT and NPT+PDT as measured by rates of escalation of care for spinal pain, and (3) compare the costs of care for recipients of NPT to PDT and NPT+PDT as measured by payer expenditures. Rigorous methods intended to reduce risk of bias and confounding will include weighted propensity scoring. The approach to this research is innovative because relatively little is known about the quality and value of non-pharmacological treatment approaches for SP among older adults overall. This project promises to challenge the status quo by assessing the value of non-pharmacologic alternatives to high-risk prescription drugs. The availability and utilization of NPT is currently often limited under Medicare by procedure, number of treatments, diagnosis, and provider specialty. Evidence of the superior value of different approaches to care of SP is expected to facilitate an innovative shift toward safer, more efficient care. The project also includes a practical plan for introducing large-scale health services research – with student participation - to an educational institution that trains complementary and integrative healthcare clinicians. The research contribution of this project is expected to be significant because it promises to inform and improve the safety, efficiency, and value of care for older adults with SP.