Table 3.
Secondary outcomes of processes of care and health care utilization over 12 months.
| Usual Care+PIPT (n = 1192) % (95% CI) | Usual Care (n = 1069) % (95% CI) | Odds Ratio (95% CI) | p-value | |
|---|---|---|---|---|
| Process of Care after Index Visit up to 12 Months | ||||
| Referral to PIPT or PT | 8.1 (6.4, 10.2) | 7.0 (5.4, 9.1) | 1.17 (0.81, 1.70) | 0.40 |
| Referral to PIPT | 3.4 (1.9, 4.8) | 0.0 (0.0, 0.0) | — | — |
| Referral to Specialist | ||||
| Complementary and | 0.4 (0.2, 1.02) | 0.6 (0.2, 1.3) | 0.75 (0.2, 0.46) | 0.63 |
| Integrative Health | 0.5 (0.2, 1.1) | 0.9 (0.4, 1.8) | 0.55 (0.17, 1.76) | 0.31 |
| Behavioral Health/ | 3.3 (2.4, 4.7) | 1.9 (1.3, 3.0) | 1.75 (1.02, 3.01) | 0.0425 |
| Counseling$ | 3·2 (2·1, 4·9) | 3·8 (2·5, 5·7) | 0·84 (0·46, 1·54) | 0·57 |
| Non-Surgical Medical | ||||
| Specialist | ||||
| Spine Surgery | ||||
| Diagnostic Imaging Order | ||||
| X-ray | 2.5 (1.7, 3.8) | 2.5 (1.7, 3.9) | 0.99 (0.60, 1.65) | 0.98 |
| MR/CT$ | 2.9 (1.9, 4.3) | 3.4 (2.3, 5.1) | 0.83 (0.46, 1.50) | 0.54 |
| Opioid Prescription | 7.0 (5.3, 9.1) | 7.5 (5.7, 9.9) | 0.92 (0.61, 1.40) | 0.69 |
| Other Prescriptions | ||||
| Acetaminophen$ | 0.4 (0.2, 1.1) | 0.7 (0.3, 1.6) | 0.58 (0.16, 2.12) | 0.41 |
| Benzodiazepines$ | 1·4 (0·8, 2·6) | 1·8 (1·0, 3·2) | 0·80 (0·55, 1·16) | 0·58 |
| Muscle relaxants | 6.7 (5.2, 8.5) | 8.2 (6.4, 10.4) | 0.78 (0.54, 1.12) | 0.23 |
| NSAIDs | 5.6 (4.1, 7.6) | 7.7 (5.7, 10.2) | 0.72 (0.46, 1.12) | 0.14 |
| 12 Month Utilization | ||||
| Primary Care Visit | 46.7 (42.3, 51.0) | 49.5 (45.0, 54.1) | 0.89 (0.69, 1.15) | 0.37 |
| Specialist Visits (Any) | 14.6 (11.9, 17.6) | 17.2 (14.02, 20.8) | 0.82 (0.59, 1.13) | 0.22 |
| 3.3 (2.2, 5.2) | 2.9 (1.8, 4.7) | 1.15 (0.59, 2.23) | 0.68 | |
| Orthopedic Surgery$ | 0.2 (0.04, 0.7) | 0.6 (0.2, 1.5) | 0.27 (0.05, 1.53) | 0.14 |
| Neurosurgery$ | 1.8 (1.0, 3.3) | 1.3 (0.6, 2.6) | 1.37 (0.53, 3.55) | 0.51 |
| Physical Medicine & | 1.9 (1.1, 3.2) | 2.4 (1.4, 4.1) | 0.79 (0.36, 1.75) | 0.56 |
| Rehabilitation$ | 7.7 (5.8, 10.1) | 11.2 (8.7, 14.4) | 0.66 (0.44, 0.99) | 0.044 |
| Anesthesiology/Pain | ||||
| Management$ | ||||
| Other | ||||
| Imaging (Any) | 15.3 (12.4, 18.7) | 17.1 (13.8, 20.9) | 0.88 (0.62, 1.24) | 0.45 |
| X-ray | 8.9 (6.7, 11.6) | 9.5 (7.1, 12.5) | 0.93 (0.61,1.44) | 0.75 |
| CT/MRI | 8.3 (6.6, 10.5) | 9.7 (7.6, 12.2) | 0.85 (0.61, 1.19) | 0.33 |
| Advanced studies# | 0.08 (0, 0.25) | 0 (–,–) | – | – |
| Interventional Pain Procedures$ | 2.3 (1.4, 3.7) | 3.3 (2.1, 5.1) | 0.70 (0.36, 1.38) | 0.30 |
| Electrodiagnostic Testing$ | 0.2 (0.1, 0.8) | 0.3 (0.1, 1.0) | 0.65 (0.11, 3.88) | 0.63 |
| Surgery (Any) | 1.7 (1.0, 2.8) | 1.2 (0.7, 2.2) | 1.37 (0.74, 2.53 | 0.31 |
| Fusion | 1.5 (0.0, 32.6) | 1.2 (0.0, 35.4) | 1.24 (0.02, 66.7) | 0.62 |
| Non-fusion# | 0·08 (0, 0·25) | 0·09 (0, 0·27) | — | – |
| Red flag# | 0.08 (0, 0.25) | 0 (–,–) | — | – |
| Other# | 0.17 (0, 0.40) | 0 (–,–) | — | – |
| Hospitalizations# | 0.17 (0, 0.41) | 0.19 (0, 0.44) | — | – |
| ED visits | 5.2 (3.7, 7.2) | 7.0 (5.1, 9.5) | 0.74 (0.45, 1.19) | 0.21 |
PIPT=Psychologically informed physical therapy. PT=Physical therapy. MR=Magnetic resonance. CT=computerized tomography. NSAIDs=non-steroidal anti-inflammatory including topical. ED=Emergency department. All proportions, odds ratios, and confidence intervals are estimated from generalized linear mixed models with random effect for clinic adjusting for site.
$
did not adjust for site due to convergence issues from small cell counts
#
estimates using survey sampling approach to adjust for clustering