Evaluation of Chronic Pain Patient Healthcare Costs before and after a Tele-Education Intervention for Primary Care Providers in Underserved Communities

Abstract

Introduction/Aim: Lack of formal training poses a significant barrier to effective chronic pain management in primary care. Project ECHO (Extension for Community Healthcare Outcomes) is a medical education model that uses weekly videoconferencing rounds and case-based learning to connect specialists with providers in resource-scarce areas. The Chronic Pain and Opioid Stewardship ECHO (“ECHO”) was launched in Ontario, Canada in 2014. We sought to describe the annual healthcare utilization costs of chronic pain patients before and after their case presentation at ECHO. Methods: We conducted a single-group before-and-after study using routinely-collected Ontario Health Insurance Plan administrative claims data between April 1, 2011 and March 31, 2018. Only the direct medical costs from the perspective of a public payer were considered. Results: Our sample consisted of 46 patients presented at ECHO between September 2014 and March 2018, representing 19% of all ECHO case presentations. The annual healthcare utilization costs per patient before and after ECHO were $2,385.54 and $2,027.91, respectively, representing a 15% decline. The largest decrease was observed in the frequency of hospital visits, while the frequency of assessment or consultation visits, use of diagnostic radiology services, overall healthcare encounters, and the number of unique billing physicians saw a slight increase in the post-ECHO period. Discussion/Conclusions: We observed notable savings in healthcare costs among patients presented at ECHO, despite a slight increase in utilization of certain healthcare services. Future studies should explore drivers of healthcare costs among ECHO patients to assess the cost-effectiveness of the program.