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Evaluating increased resource use in fibromyalgia using electronic health records

机译：使用电子健康记录评估纤维肌痛中资源的增加使用

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Objective: The management of fibromyalgia (FM), a chronic musculoskeletal disease, remains challenging, and patients with FM are often characterized by high health care resource utilization. This study sought to explore potential drivers of all-cause health care resource utilization and other factors associated with high resource use, using a large electronic health records (EHR) database to explore data from patients diagnosed with FM. Methods: This was a retrospective analysis of de-identified EHR data from the Humedica database. Adults (≥18 years) with FM were identified based on ≥2 International Classification of Diseases, Ninth Revision codes for FM (729.1) ≥30 days apart between January 1, 2008 and December 31, 2012 and were required to have evidence of ≥12 months continuous care pre- and post-index; first FM diagnosis was the index event; 12-month pre- and post-index reporting periods. Multivariable analysis evaluated relationships between variables and resource utilization. Results: Patients were predominantly female (81.4%), Caucasian (87.7%), with a mean (standard deviation) age of 54.4 (14.8) years. The highest health care resource utilization was observed for the categories of “medication orders” and “physician office visits,” with 12-month post-index means of 21.2 (21.5) drug orders/patient and 15.1 (18.1) office visits/patient; the latter accounted for 73.3% of all health care visits. Opioids were the most common prescription medication, 44.3% of all patients. The chance of high resource use was significantly increased ( P <0.001) 26% among African-Americans vs Caucasians and for patients with specific comorbid conditions ranging from 6% (musculoskeletal pain or depression/bipolar disorder) to 21% (congestive heart failure). Factors significantly associated with increased medications ordered included being female ( P <0.001) and specific comorbid conditions ( P <0.05). Conclusion: Physician office visits and pharmacotherapy orders were key drivers of all-cause health care utilization, with demographic factors, opioid use, and specific comorbidities associated with resource intensity. Health systems and providers may find their EHRs to be a useful tool for identifying and managing resource-intensive FM patients.
机译：目的：慢性肌骨骼疾病纤维肌痛（FM）的治疗仍然具有挑战性，并且FM患者通常具有高医疗资源利用率的特点。这项研究试图通过使用大型电子健康记录（EHR）数据库来探索确诊为FM的患者的数据，以探索全因医疗资源利用以及与高资源使用相关的其他因素的潜在驱动因素。方法：这是对Humedica数据库中未识别的EHR数据的回顾性分析。根据≥2国际疾病分类，第FM的第9修订代码（729.1）在2008年1月1日至2012年12月31日之间相隔30天以上，鉴定出患有FM的成年人（≥18岁），并要求他们提供≥12的证据连续几个月的护理前后指数; FM诊断首先是指数事件。前12个月的索引编制前后报告期。多变量分析评估了变量与资源利用之间的关系。结果：患者主要为女性（81.4％），白人（87.7％），平均（标准差）年龄为54.4（14.8）岁。在“用药顺序”和“内科就诊”类别中，卫生保健资源利用率最高，十二个月指数后平均值为21.2（21.5）药物/患者和15.1（18.1）/患者。后者占所有就诊次数的73.3％。阿片类药物是最常见的处方药，占所有患者的44.3％。非洲裔美国人与高加索人以及患有特定合并症的患者（从6％（肌肉骨骼疼痛或抑郁/双相情感障碍）到21％（充血性心力衰竭），高资源使用的机会显着增加（P <0.001）26％。 。与订购药物增加显着相关的因素包括女性（P <0.001）和特定的合并症（P <0.05）。结论：医师上门拜访和药物治疗是全因医疗保健利用的主要驱动力，人口统计学因素，阿片类药物的使用以及与资源强度相关的特定合并症。卫生系统和提供者可能会发现其EHR是识别和管理资源密集型FM患者的有用工具。

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