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A naturalistic experiment evaluating the impact of Medicaid treatment reimbursement changes on opioid prescribing and patient outcomes among patients with low back pain
Investigator (PI): DeBar, Lynn
Performing Organization (PO): (Current): Kaiser Permanente, Kaiser Permanente Washington Health Research Institute / (206) 287-2900
(Past): Kaiser Permanente, Center for Health Research, Center for Health Research Northwest / (503) 335-2400
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2016
Final Year: 2022
Record Source/Award ID: PCORI/UOP-1609-36568
Funding: Total Award Amount: $5,782,287
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Low back pain is one of the most common reasons patients seek medical care. Low back pain can have a big impact on patients' quality of life and functioning. Patients and providers are becoming more frustrated with common low back pain treatments like steroid injections and the long-term use of opioid medications, which have been shown to have limited long-term impact on patients' pain and day-to-day functioning and can have safety risks. The state of Oregon is in the process of changing what low back pain treatments they will pay for. This started to affect those insured by Medicaid in July 2016 and will be completely implemented by January 2018. These changes will end payments for treatments like chronic opioid therapy and injections. It will also increase the use of nondrug treatments such as cognitive behavioral therapy, supervised exercise therapy, intensive interdisciplinary rehabilitation, physical/occupational therapy, and complementary medical approaches (acupuncture, osteopathic/chiropractic manipulation, yoga, and massage). While experts agree we must reduce opioid use, Oregon is the first state to try such strong measures to promote nondrug treatments and prevent the use of chronic opioid treatment for low back pain. Our study will evaluate physicians' opioid prescribing practices and other outcomes patients value as Oregon Medicaid reimbursement changes for low back pain treatment creates the opportunity for a "natural experiment." We will compare outcomes among patients with low back pain in Oregon who will have access to these expanded nondrug treatments to matched patients seen in comparable clinics in California where services for low back pain are restricted to more conventional care. We will compare patients' pain severity, pain-related functioning, and satisfaction with care. While we think the Oregon Medicaid change will result in many positive changes, limiting the use of opioids and pain procedures like injections may motivate some individuals to use illegal substances. As such, we will also compare the reported use of illegal and other recreational drugs. Finally, we will look at overall changes in the health care services for pain, including new starts of chronic opioid treatment used by patients served in clinics with "enhanced" services (Oregon) compared to those in "conventional" service clinics (California). Patients with low back pain who get their care in community health clinics in Oregon and California will participant in this study. Participating patients will be asked to complete a short online survey every three months. We will also interview some patients and health care providers to get more in-depth information about their experiences with these changes in health care services.
MeSH Terms:
  • Acupuncture
  • Analgesics, Opioid /*economics
  • /*therapeutic use
  • California
  • Chiropractic
  • Cognitive Behavioral Therapy
  • Complementary Therapies
  • Exercise Therapy
  • Health Care Reform
  • Health Services Accessibility
  • Health Services Research
  • Humans
  • Internet
  • Low Back Pain /*drug therapy
  • Massage
  • Medicaid
  • Occupational Therapy
  • Opioid-Related Disorders /*prevention & control
  • Oregon
  • Outcome Assessment, Health Care
  • Patient Safety
  • Physical Therapy Specialty
  • Practice Patterns, Physicians'
  • Quality of Life
  • Rehabilitation
  • * Reimbursement Mechanisms
  • Steroids /therapeutic use
  • Substance-Related Disorders
  • Yoga
Country: United States || United States
State: Washington || Oregon
Zip Code: 97227 / 98101
UI: 20181702
CTgovId: NCT03393143
Project Status: Ongoing
Record History: ('2021: PO changed.\n2019: Project extended to 2022\n2018: Project extended to 2021',) ("Alternate Title: Testing one state's effort to prevent unsafe treatments for patients with back pain--Back on Track",) ('Project start date corrected to 2017 per PCORI, 2/4/2020',)