Xuemei Luo

Estimates and patterns of direct health care expenditures among individuals with back pain in the United States.

Study Design. Secondary analysis of the 1998 Medical Expenditure Panel Survey. Objective. To estimate total health care expenditures incurred by individuals with back pain in the United States, calculate the incremental expenditures attributable to back pain among these individuals, and describe health care expenditure patterns of individuals with back pain. Summary of Background Data. There is a lack of updated information on health care expenditures and expenditure patterns for individuals with back pain in the United States. Methods. This study used data from the 1998 Medical Expenditure Panel Survey, a national survey on health care utilization and expenditures. Total health care expenditures and per-capita expenditures among individuals with back pain were calculated. Multivariate regression models were used to estimate the incremental expenditures attributable to back pain. The expenditure patterns were examined by stratifying individuals with back pain by sociodemographic characteristics and medical diagnosis, and calculating per-capita expenditures for each stratum. Results. In 1998, total health care expenditures incurred by individuals with back pain in the United States reached

Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain.

90.7 billion and total incremental expenditures attributable to back pain among these persons were approximately

Patterns and Trends in Opioid Use among Individuals with Back Pain in the United States

26.3 billion. On average, individuals with back pain incurred health care expenditures about 60% higher than individuals without back pain (

Simulation of pediatric trauma stabilization in 35 north carolina emergency departments : Identification of targets for performance improvement

3,498 vs.

Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States.

2,178). Among back pain individuals, at least 75% of service expenditures were attributed to those with top 25% expenditure, and per-capita expenditures were generally higher for those who were older, female, white, medically insured, or suffered from disc disorders. Conclusions. Health care expenditures for back pain in the United States in 1998 were substantial. The expenditures demonstrated wide variations among individuals with different clinical, demographic, and socioeconomic characteristics.

Simulated Pediatric Trauma Team Management: Assessment of an Educational Intervention

Study Design. Secondary analysis of data collected from spine patients’ normal clinic visits from 1998 to 2001. Objective. To evaluate the reliability, validity, and responsiveness of the short form 12-item survey in patients with back pain. Summary of Background Data. The reliability, validity, and responsiveness of the short form 12-item survey in patients with back pain has not been previously evaluated. Methods. Patients were asked to complete a comprehensive computerized survey questionnaire during their regular clinic visits. A total of 2520 patients who indicated in their first surveys that they had back pain were included in the study of the reliability and validity of the short form 12-item survey. Of these, 506 patients completed another survey within 3–6 months of follow-up and were included in the responsiveness evaluation. Results. The two summary scales of the short form 12-item survey, physical component summary and mental component summary, demonstrated internal consistency reliability, with Cronbach alpha for both scales exceeding the recommended level of 0.70. Correlation of physical component summary and mental component summary with six other measures theoretically related or unrelated to these scales performed as expected without exception, demonstrating the construct validity of the short form 12-item survey. The responsiveness of the short form 12-item survey was supported by several pieces of evidence. First, the changes in physical component summary and mental component summary scores were correlated with the changes in back pain intensity. Second, for patients whose back pain improved, there was a significant increase in the follow-up physical component summary and mental component summary scores as compared to the baseline. Third, small to moderate effect size was observed for patients whose back pain became improved or became worse. Conclusions. The short form 12-item survey demonstrated good internal consistency reliability, construct validity, and responsiveness in patients with back pain.

Evaluation of a Web-based education program on reducing medication dosing error: a multicenter, randomized controlled trial.

Study Design. Secondary analysis of Medical Expenditure Panel Survey from 1996 to 1999. Objective. To examine patterns in opioid use in 1996, 1997, 1998, and 1999 among individuals with back pain in the United States and to investigate trends in the use of overall and individual opioid category. Summary of Background Data. To the authors’ best knowledge, no study has examined at a national level the patterns and trends in opioid use among individuals with back pain in the United States. Methods. Individuals with back pain were stratified by sociodemographic characteristics and geographic regions. Rates of overall opioid use were compared among different strata by the use of simple and multivariate logistic regression models. To investigate trends in opioid use, use rates of the overall and individual opioid category in each year were calculated and compared. Results. From 1996 to 1999, wide variations in overall opioid use were consistently observed among individuals with different educational levels, family income, and health insurance status. Regional variation in opioid use was also observed for most of the 4 years. After adjustment for covariates, health insurance status and geographic regions were consistent predictors of opioid use from 1997 to 1999. Trend analysis indicated that the rates of overall opioid use increased slightly across the 4-year span. Among individual opioid categories, the use of oxycodone or hydrocodone increased, whereas the use of propoxyphene decreased. Conclusions. The variation in overall opioid use among individuals with back pain with different sociodemographic characteristics and from different geographic regions suggested an opportunity to improve opioid prescribing patterns. The increase in the use of hydrocodone and oxycodone indicated a need to better assess the efficacy and safety associated with these drugs among individuals with back pain.

Effectiveness and safety of apixaban versus warfarin in non-valvular atrial fibrillation patients in "real-world" clinical practice: a propensity-matched analysis of 76,940 patients

OBJECTIVE. Trauma is the leading cause of death in children. Most children present to community hospital emergency departments (EDs) for initial stabilization. Thus, all EDs must be prepared to care for injured children. The objectives of this study were to (1) characterize the quality of trauma stabilization efforts in EDs and (2) identify targets for educational interventions. METHODS. This was a prospective observational study of simulated trauma stabilizations, that is, “mock codes,” at 35 North Carolina EDs. An evaluation tool was created to score each mock code on 44 stabilization tasks. Primary outcomes were (1) interrater reliability of tool, (2) overall performance by each ED, and (3) performance per stabilization task. RESULTS. Evaluation-tool interrater reliability was excellent. The median number of stabilization tasks that needed improvement by the EDs was 25 (57%) of 44 tasks. Although problems were numerous and varied, many EDs need improvement in tasks uniquely important and/or complicated in pediatric resuscitations, including (1) estimating a childs weight (17 of 35 EDs [49%]), (2) preparing for intraosseous needle placement (24 of 35 [69%]), (3) ordering intravenous fluid boluses (31 of 35 [89%]), (4) applying warming measures (34 of 35 [97%]), and (5) ordering dextrose for hypoglycemia (34 of 35 [97%]). CONCLUSIONS. This study used simulation to identify deficiencies in stabilization of children presenting to EDs, revealing that mistakes are ubiquitous. ED personnel were universally receptive to feedback. Future research should investigate whether interventions aimed at improving identified deficiencies can improve trauma stabilization performance and, ultimately, the outcomes of children who present to EDs.

Impact of upper and lower gastrointestinal blood loss on healthcare utilization and costs: a systematic review

Study Design. Secondary analysis of the 2000 Medical Expenditure Panel Survey (MEPS). Objective. To examine national prescription patterns of nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants among individuals with back pain in the United States. Summary of Background Data. There is a lack of information on national prescription patterns of NSAIDs and muscle relaxants among individuals with back pain in the United States. Methods. Traditional NSAIDs, cyclooxygenase-2-specific (COX-2) inhibitors, and muscle relaxants were investigated. Individuals with back pain were stratified by socio-demographic characteristics and geographic regions. For each medication category, overall prescribing frequency was compared across different strata and individual drug prescription was analyzed. Results. Traditional NSAIDs, COX-2 inhibitors, and muscle relaxants, respectively, accounted for 16.3%, 10%, and 18.5% of total prescriptions for back pain in 2000. Among individual drugs, ibuprofen and naproxen accounted for most of the prescriptions for traditional NSAIDs (60%), whereas two thirds of the prescriptions for muscle relaxants were attributable to cyclobenzaprine, carisoprodol, and methocarbamol. Prescription of COX-2 inhibitors or muscle relaxants demonstrated wide variations across different regions. Several individual characteristics including age, race, and educational level were associated with the prescription of some of the medications. Conclusions. Neither traditional NSAIDs, nor COX-2 inhibitors, nor muscle relaxants dominated prescriptions for back pain. However, a small number of individual drugs were attributable to most of the prescriptions for traditional NSAIDs or muscle relaxants. The prescription of some of the medications demonstrated wide variations across different regions or different racial and educational groups. More studies are needed to understand the source of the variations and what constitutes optimal prescribing.

Opportunities for performance improvement in relation to medication administration during pediatric stabilization

Objectives: Trauma is the leading cause of death in children. The quality of initial medical care received by injured children contributes to outcomes. Our objective was to assess effectiveness of an educational intervention on performance of emergency department (ED) teams during simulated pediatric trauma resuscitations. Methods: A prospective, preinterventional and postinterventional study was performed on a random, convenience sample of 17% of EDs in North Carolina. An unannounced simulated pediatric trauma resuscitation was conducted at each site, followed by an educational intervention and a second visit 6 months later. The key outcome measure was team performance on a clinical assessment tool previously described that included 44 resuscitation tasks deemed critical to appropriate management of pediatric trauma resuscitation. Results: All 18 sites consented and completed the study. Interrater reliability was excellent, weighted &kgr; = 0.80 (95% confidence interval, 0.76-0.84). After the educational intervention, the mean (± SD) number of the 44 tasks passed by each ED team increased from 17.7 ± 4.3 to 26.6 ± 5.8 (P < 0.001). At the individual task level, the scores on 37 (84%) of the 44 tasks improved, of which 11 (25%) of the 44 tasks improved significantly. Conclusions: This study demonstrated that an on-site educational intervention was effective in improving the performance of ED teams during simulated pediatric trauma resuscitations. Postintervention performance was more consistent with the Pediatric Advanced Life Support and Advanced Trauma Life Support guidelines. Further studies are needed to determine if improved performance in a simulated scenario leads to improved performance and better clinical outcomes of critically injured children.