Heterogeneity Among Hospitals in the Percentages of All Lumbosacral Epidural Steroid Injections Where the Patient Had Received 4 or More in the Previous Year

What is it about?

Lumbosacral epidural steroid injections are administered to patients who have lower back pain. Guidelines recommend at most 4 per year. Clinical trials have confirmed that 1 or 2 per year reduce pain. We examined the percentage of injections given that were the 5th or greater within a year in Iowa. We found that among the 39 hospitals in Iowa performing the most injections, there were 6 hospitals at which the percentages of injections that >4 were larger than expected. There also were hospitals that performed fewer than average. This heterogeneity cannot be explained by different in patient conditions. The heterogeneity warrants additional study. Maybe the annual count of steroid injections per patient can be a clinical quality measure for the care received by patients with lower back pain. Alternatively, maybe payment should be greater when injections are in accordance with guidelines.

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