Research Paper Title

Does Healthcare Utilization Before Hip Arthroscopy Predict Healthcare Utilization After Surgery in the United States Military Health System? An Investigation Into Health Seeking Behavior.

Background

The influence of prior patterns of healthcare utilisation on future healthcare utilisation has had minimal investigation in populations with musculoskeletal disorders.

The purpose of this study was to explore the relationship between pre-surgical healthcare utilisation and post-surgical healthcare utilisation in a population of patients undergoing hip surgery in the United States Military Health System.

Methods

Person-level data were captured for patients undergoing hip arthroscopy in the Military Health System were collected from 2003 to 2015, capturing all encounters 12 months before and 24 months after surgery for every individual. Cluster analysis was used to categorise high and low healthcare utilisers based on pre-operative healthcare visits. Un-adjusted and adjusted Poisson and Generalised Linear Models were performed. Healthcare utilisation outcomes were targeted including costs, visits, and medication use.

Results

There were 1850 individuals in the final cohort (mean age=32.18, male=55.4%). The high healthcare utilisation group averaged 57.69(SD=25.86) visits compared to 20.42(SD=8.36) visits in the low utilisation group. There were significant differences between groups for total healthcare visits(58.17; 95CI 57.39,58.58), total healthcare costs($11,539.71; 95CI $10,557.26,$12,595.04), hip-related visits(12.77; 95CI 12.59,12.96), hip-related costs($3,325.07; 95CI $2,886.43,$3,804.51), days’ supply of pain medications(752.67; 95CI 751.24,754.11), opioid prescriptions(48.83; 95CI 48.47,49.21), and costs of pain medications($1,074.80; 95CI $1,011.91,$1,137.68).

Conclusions

Pre-surgical patterns of healthcare utilisation were associated with post-surgical patterns of healthcare utilisation, indicating that those who used more care before surgery also used more care after surgery. Clinicians should consider prior patterns of healthcare utilisation, including utilisation unrelated to the index condition, when determining care plans and prognosis.

Reference

Clewley, D., Rhon, D.I., Flynn, T., Sissel, C.D. & Cook, C. (2018) Does Healthcare Utilization Before Hip Arthroscopy Predict Healthcare Utilization After Surgery in the United States Military Health System? An Investigation Into Health Seeking Behavior. The Journal of Orthopaedic and Sports Physical Therapy. 1-27. doi: 10.2519/jospt.2018.8259. [Epub ahead of print].