HEALTH-CARE UTILIZATION AND REFERRAL PATTERNS IN THE INITIAL MANAGEMENT OF NEW-ONSET, UNCOMPLICATED, LOW-BACK WORKERS-COMPENSATION DISABILITY CLAIMS

Most episodes of low back pain are considered non-specific in nature, with the vast majority resolving within 2 weeks and almost all resolvi ng within 6 weeks regardless of the medical intervention. Recently pub lished clinical guidelines have clearly delineated a limited set of ci rcumstances that would indicate the need for specialist referral. The purpose of this study was to describe the healthcare utilization and p hysician referral patterns for new-onset, uncomplicated, low back work ers' compensation disability cases randomly selected from a large insu rance carrier data source. The provision of care in urgent care center s and emergency departments for both initial and main sources of care occurred more frequently than was probably indicated. For this selecte d group of uncomplicated low back pain cases, specialist care was prov ided more commonly than would be expected or indicated (36 % of the sa mple was seen by a surgeon, while only 2 % received surgery). In addit ion, referral to specialists (other than occupational medicine special ists) was often made sooner than would be expected or indicated, with a median of 13 days for such referrals. Such overutilization of resour ces can reasonably be expected to increase overall medical costs.