PCORI-1609-36568 A Naturalistic Experiment to Evaluate the Impact of Changes to Oregon Medicaid Treatment Reimbursement for Back Pain on Opioid Prescribing and Patient Outcomes

Status:Enrolling by invitation
Conditions:Back Pain, Orthopedic, Pain
Therapuetic Areas:Musculoskeletal, Orthopedics / Podiatry
Age Range:18 - 65
Start Date:May 31, 2018
End Date:February 28, 2020

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A Naturalistic Experiment Evaluating the Impact of Medicaid Treatment Reimbursement Changes on Opioid Prescribing and Patient Outcomes Among Patients With Back Pain

Back pain is one of the most common reasons patients seek medical care, and it can have a big
impact on patients' quality of life and functioning. Patients and providers are becoming more
frustrated with common back pain treatments like the long-term use of opioid medications and
steroid injections, 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 back and neck pain treatments they
will cover for its Medicaid enrollees. 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. They 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 that opioid use must be reduced, Oregon is among the first states to try
such strong measures to promote nondrug treatments and prevent the use of chronic opioid
treatment for back and neck pain.

The Oregon Medicaid reimbursement changes for back and neck pain treatment create the
opportunity for a "natural experiment." In this mixed-methods, observational study, we will
evaluate the impact of the reimbursement changes by comparing outcomes among patients with
back pain in Oregon who will have access to these expanded nondrug treatments to similar
patients seen in comparable clinics in California where expanded services for back and neck
pain are not covered by the type of comprehensive payer incentive undertaken in Oregon.

Specifically, we will use electronic health record, Medicaid claims data, and data obtained
from a longitudinal patient survey to assess the impact of the changes on:

- Opioid prescribing

- Patients' use of pain-related health care services

- Patients' pain severity, pain related functioning, and satisfaction with care

- Adverse events, such as the use of illegal and other recreational drugs (While we expect
the Oregon Medicaid change to result in many positive changes, limiting the use of
opioids and pain reducing procedures like injections may motivate some individuals to
use drugs that were not prescribed by their doctor.)

In addition, we will use qualitative research methods to characterize the facilitators and
barriers experienced by patients, health care providers, and clinic administrators and staff
in adopting the Medicaid reimbursement changes and their satisfaction with the constellation
of available and utilized services.

Thus, this study has three components: 1) patient survey, 2) electronic health record-based
study, and 3) qualitative evaluation.

For the patient survey, the inclusion criteria are:

1. Adults age 18-65 years

2. Insured by Medicaid

3. Have back or neck pain (based on ICD-CM diagnosis)

4. Receive their primary health care at participating OCHIN member federally qualified
health centers in Oregon and California

For the patient survey, the exclusion criteria are:

1. Patients with current malignant cancer diagnosis

2. Any evidence of patient having received hospice or other end-of-life palliative care
within the past year

For the qualitative evaluation, the inclusion criterion is:

1. Patient, clinician, or administrator who has experience with the Oregon Medicaid
reimbursement other pain practice changes in health care services for back and neck pain
We found this trial at
Portland, Oregon 97201
Portland, OR
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