Abstract
BackgroundA vast body of literature has documented regional variations in healthcare utilization rates. The extent to which such variations are “unwarranted” critically depends on whether there are corresponding variations in patients’ needs. Using a unique medical registry, the current paper investigated any associations between utilization rates and patients’ needs, as measured by two patient-reported outcome measures (PROMs).MethodsThis observational panel study merged patient-level data from the Norwegian Patient Registry (NPR), Statistics Norway, and the Norwegian Registry for Spine Surgery (NORspine) for individuals who received surgery for degenerative lumbar spine disorders in 2010–2015. NPR consists of hospital administration data. NORspine includes two PROMs: the generic health-related quality of life instrument EQ-5D and the disease-specific, health-related quality of life instrument Oswestry Disability Index (ODI). Measurements were assessed at baseline and at 3 and 12 months post-surgery and included a wide range of patient characteristics. Our case sample included 15,810 individuals. We analyzed all data using generalized estimating equations.ResultsOur results show that as treatment rates increase, patients have better health at baseline. Furthermore, increased treatment rates are associated with smaller health gain.ConclusionThe correlation between treatment rates and patients health indicate the presence of unwarranted variation in treatment rates for lumbar spine disorders.
Highlights
A vast body of literature has documented regional variations in healthcare utilization rates
A sample representative of the treated population demonstrates how need (i.e., “ill health” and “capacity to benefit”) varied across hospital regions. We show how such differences are associate with regional variation in treatment rates
Additional file 1: Table A1 in appendix shows the statistics of covariates
Summary
A vast body of literature has documented regional variations in healthcare utilization rates. Empirical findings demonstrate how they result from factors unrelated to patients’ need for treatment – i.e. unwarranted variations [3]. Earlier studies demonstrated how healthcare services exhibit diminishing returns [4,5,6], a Wennberg suggested a framework for analysis of variation in population based treatment rates that has been widely adopted [8]. Effective care refers to interventions with few treatment options, for which benefits far outweigh risk and the optimal rate of utilization is 100% of patients who need treatment according to evidence-based guidelines. Care is deemed preference-sensitive when diagnostic test results are open to interpretation and two or more generally accepted treatment options are available. Variations in surgery for degenerative disorders of the spine might exchibit variation from all three categories
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