Browsing by Subject "Outcome and Process Assessment, Health Care"
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Item A Cost Utility Analysis of Interdisciplinary Early Intervention Versus Treatment as Usual for an At-Risk Population with Acute Low Back Pain(2009-09-04) Rogerson, Mark D.; Gatchel, Robert J.Chronic pain is a costly and debilitating condition that has proven difficult to treat solely with medical interventions due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study evaluated effectiveness and associated costs by using the objective, standard approach of a cost utility analysis. Individuals with acute low back pain that was considered at high-risk for becoming chronic (according to a previously-demonstrated algorithm) were randomized to either treatment as usual or an interdisciplinary early intervention program. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years (QALYs) from pre-treatment baseline to 12-month follow-up, and associated medical and employment costs were gathered every 3 months for 1 year. Results indicated that subjects improved significantly from pre-treatment to one-year follow-up, and that the early intervention group reported fewer healthcare visits and missed workdays. A cost utility analysis was conducted utilizing 1,000 bootstrapped samples, and the majority of samples indicated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. Within a generally-accepted range of acceptable costs, the early intervention treatment was the preferred option in 85% to 93% of samples. Sensitivity analyses indicated that these effects were robust to changes in estimated values for associated costs. These results indicate encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted treatment.Item Early Intervention Options for Acute Low Back Pain Patients: A Prospective One-Year Follow-Up Study(2009-09-04) Whitfill, Travis A.; Gatchel, Robert J.This study represents a continuation of research that has focused on the treatment of acute low back pain (ALBP) patients using techniques designed to address the psychosocial, as well as physical, aspects of pain. Initially, an algorithm was developed by Gatchel et al. (1995a) to identify patients suffering from ALBP who were at high-risk for developing chronic low back pain (CLBP). An interdisciplinary early intervention program was then implemented by Gatchel et al. (2003) to discourage the progression of ALBP to CLBP. Previous studies demonstrated the effectiveness of the early intervention program in reducing levels of pain and disability as compared to those not receiving additional treatment. Another advantage that the treatment group had, relative to the "treatment as usual" group, was cost-effectiveness, as evidenced by lower levels of healthcare utilization, time away from work and medication costs. Due to the important position that work status holds in a discussion of disability and costs associated with injury, a work transition component was added to the early intervention program. Individuals considered high-risk for developing LBP were randomly assigned into one of four groups: early intervention (EI); early intervention with work transition (EI/WT); work transition (NI/W); and non-intervention (NI). A one-year prospective study looked at how these groups differed regarding outcome measures designed to evaluate pain level, coping abilities and work status (Holberg&Gatchel, 2007). Earlier findings were confirmed regarding the effectiveness of early intervention programs at addressing these issues, but a small sample size did not allow for conclusive results. The current study expanded upon previous research by utilizing additional instruments in the measurement of the physical and psychosocial status of those at high risk for developing CLBP, including cortisol analyses intended to demonstrate the interplay between the physical and mental aspects of pain. In addition to these measures, an increase in sample size allowed for greater statistical power and more definitive statements regarding the long-term efficacy of early intervention interdisciplinary programs for the treatment of ALBP.Item Population health care interventions: outcomes & equity considerations(2024-01-05) Liao, Joshua M.