Highlights
- •Patient-reported outcome measures (PROMs) are key components of value-based healthcare.
- •In patients with adult spinal deformity (ASD), Medicaid patients showed worse baseline PROMs.
- •Stakeholders in ASD care should account for baseline PROM differences to provide equitable care.
Abstract
Background
Patient-reported outcome measures (PROMs) are increasingly recognized as a key component
of healthcare value, allowing comparison of therapeutic impact across different specialties.
Prior literature suggests that insurance type may be associated with differing baseline
PROMs among patients with degenerative conditions, including lumbar stenosis and hip
arthritis. This association, however, has not been investigated for adult spinal deformity
(ASD).
Methods
Baseline PROMs were reviewed from 207 patients with ASD presenting for treatment between
2015 and 2019. The Patient-Reported Outcomes Measurement Information System (PROMIS)
Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, PROMIS Global-Physical,
and visual analogue scale (VAS) for back and leg pain were assessed. Negative binomial
regression was used to determine the impact of sociodemographic factors, including
insurance type, on severity of symptoms and degree of disability at baseline.
Results
Mean age of the study population was 62.2 +/- 15 years, with 61.8 % male prevalence.
The Medicaid population had a greater proportion of Hispanic and non-English speaking
patients, compared to commercially insured patients. Medicaid insured patients had
significantly greater VAS low back pain scores compared with commercially insured
individuals (IRR 1.535, 95 % CI 1.122–2.101, p = 0.007).
Conclusions
Medicaid insured patients demonstrated worse baseline PROMs at presentation with ASD,
as compared to commercially insured or Medicare patients. Stakeholders across spine
care delivery should elucidate the etiology of baseline disparities in ASD patients,
as they may result from health system asymmetries. In an ecosystem moving toward value-driven
treatment algorithms, accounting for and addressing these differences will be necessary
to provide equitable care for ASD populations.
Keywords
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Article info
Publication history
Accepted:
July 15,
2022
Received:
April 11,
2022
Identification
Copyright
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