{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T10:51:40Z","timestamp":1791543100352,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["R01MD017719"],"award-info":[{"award-number":["R01MD017719"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"ABSTRACT<\/jats:title>\n \n Importance<\/jats:title>\n Low back pain (LBP) is a major cause of disability and poor quality of life among older adults. Clinical guidelines recommend non\u2010pharmacological therapies, such as physical therapy (PT), as the first\u2010line treatment for high\u2010value care. Despite the fact that more than half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), there is no knowledge about the patterns of high\u2010value LBP care within this population.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To characterize high\u2010 and low\u2010value LBP care among MA beneficiaries and identify factors associated with receipt of high\u2010value care.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n We conducted a retrospective cohort study using a 20% random sample of 2021 MA outpatient and carrier encounter data. Beneficiaries aged \u2265\u200966\u2009years with a new LBP diagnosis between April 1 and September 30, 2021, were followed for 90\u2009days. The study outcomes include high\u2010 and low\u2010value care, defined by the timing and receipt of physical therapy, imaging, and spinal injections.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 181,980 beneficiaries with newly diagnosed LBP, 87,305 received additional care within 90\u2009days. Of these, 21.6% received high\u2010value care and 78.4% received low\u2010value care. Imaging without PT was the most common low\u2010value care pattern, whereas PT alone was the most common high\u2010value care pattern. Older age, Hispanic ethnicity, multiple comorbidities, lower MA plan ratings, and index visits with surgeons or pain specialists were associated with lower odds of receiving high\u2010value care. County\u2010level variation was observed, with rural residence and greater neighborhood socioeconomic deprivation associated with lower receipt of high\u2010value care.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Most older adults enrolled in MA plans with LBP did not receive guideline\u2010concordant, high\u2010value care. Geographic and socioeconomic disparities highlight opportunities to improve equitable access to evidence\u2010based LBP management in older adults enrolled in MA plans.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.70779","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T10:06:12Z","timestamp":1791540372000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variation in High Value Care for Low Back Pain Among Older Adults Enrolled in Medicare Advantage Plans"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0125-6759","authenticated-orcid":false,"given":"Amit","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Physical Therapy & Athletic Training, College of Health University of Utah Salt Lake City Utah USA"},{"name":"Center for Research on Race, Health Justice, and Public Policy University of Utah Salt Lake City Utah USA"},{"name":"Department of Population Health Sciences, School of Medicine University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Deutscher","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy & Athletic Training, College of Health University of Utah Salt Lake City Utah USA"},{"name":"Net Health Systems, Inc. Pittsburgh Pennsylvania USA"},{"name":"Maccabitech Institute for Research & Innovation Maccabi Healthcare Services Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0779-714X","authenticated-orcid":false,"given":"Lin\u2010Na","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy & Athletic Training, College of Health University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M.","family":"Fritz","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy & Athletic Training, College of Health University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"6","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/S2665-9913(23)00098-X","article-title":"Global, Regional, and National Burden of Low Back Pain, 1990\u20102020, Its Attributable Risk Factors, and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021","volume":"5","author":"GBD 2021 Low Back Pain Collaborators","year":"2023","journal-title":"Lancet Rheumatology"},{"issue":"7","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"493","DOI":"10.7326\/M16-2459","article-title":"Nonpharmacologic Therapies for Low Back Pain: Systematic Review for an American College of Physicians Clinical Practice Guideline","volume":"166","author":"Chou R.","year":"2017","journal-title":"Annals of Internal Medicine"},{"key":"e_1_2_12_4_1","unstructured":"A. C.Skelly R.Chou J. R.Dettori et\u00a0al. \u201cNoninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review \u201d Comparative Effectiveness Review No. 209 (Prepared by the Pacific Northwest Evidence\u2010Based Practice Center Under Contract No. 290\u20102015\u201000009\u2010I). AHRQ Publication No. 18\u2010EHC013\u2010EF 2018."},{"issue":"12","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1016\/j.spinee.2025.07.015","article-title":"Agreement Between High\u2010Quality Clinical Practice Guidelines in Their Treatment Recommendations for Low Back Pain: A Systematic Review","volume":"25","author":"McKenzie B. J.","year":"2025","journal-title":"Spine Journal"},{"issue":"2","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/papr.13142","article-title":"Low\u2010Value Care in Musculoskeletal Health Care: Is There a Way Forward?","volume":"22","author":"Hartvigsen J.","year":"2022","journal-title":"Pain Practice"},{"issue":"2","key":"e_1_2_12_7_1","first-page":"146","article-title":"Low\u2010Value Interventions to Deimplement: A Secondary Analysis of a Systematic Review of Low Back Pain Clinical Practice Guidelines","volume":"17","author":"Tai D.","year":"2025","journal-title":"PM & R: The Journal of Injury, Function, and Rehabilitation"},{"issue":"12","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jpain.2024.104667","article-title":"Treatment Among Commercial and Medicaid\u2010Insured Adults With Incident Chronic Pain Episodes","volume":"25","author":"Bohm M. K.","year":"2024","journal-title":"Journal of Pain"},{"issue":"25","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1097\/BRS.0b013e31825d32f5","article-title":"Primary Care Referral of Patients With a New Consultation for Low Back Pain to Physical Therapy: The Impact of the Timing and Content of Care on Future Healthcare Utilization and Costs","volume":"37","author":"Fritz J. M.","year":"2012","journal-title":"Spine"},{"issue":"4","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/BRS.0000000000004118","article-title":"Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries","volume":"47","author":"Whedon J. M.","year":"2022","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1007\/s11606-022-07823-8","article-title":"Comparison of Low\u2010Value Care Among Commercial and Medicaid Enrollees","volume":"38","author":"Ellison J. E.","year":"2023","journal-title":"Journal of General Internal Medicine"},{"issue":"2","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.47178","article-title":"Cross\u2010Sectional Trends in Potentially Low\u2010Value Services for Commercially Insured Patients With Chronic Low Back Pain","volume":"5","author":"Pham T.","year":"2022","journal-title":"JAMA Network Open"},{"key":"e_1_2_12_13_1","unstructured":"Institute of Medicine. Committee on Advancing Pain Research C Education \u201cRelieving Pain in America: A Blueprint for Transforming Prevention Care Education and Research \u201d 2011."},{"key":"e_1_2_12_14_1","unstructured":"National Pain Strategy \u201cA Comprehensive Population Health\u2010Level Strategy for Pain \u201d 2016."},{"issue":"9","key":"e_1_2_12_15_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.33251","article-title":"Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD","volume":"6","author":"Bhondoekhan F.","year":"2023","journal-title":"JAMA Network Open"},{"key":"e_1_2_12_16_1","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1392074","article-title":"Sociodemographic Determinants of Health Inequities in Low Back Pain: A Narrative Review","volume":"12","author":"Mathieu J.","year":"2024","journal-title":"Frontiers in Public Health"},{"key":"e_1_2_12_17_1","volume-title":"Medicare Advantage in 2026: Enrollment Update and Key Trends","author":"Freed M.","year":"2026"},{"issue":"2","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2026.0095","article-title":"Association of Dual Eligibility and Medicare Type With Quality of Postacute Care After Stroke","volume":"9","author":"Karmarkar A. M.","year":"2026","journal-title":"JAMA Network Open"},{"issue":"9","key":"e_1_2_12_19_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.10622","article-title":"Quality of Home Health Agencies Serving Traditional Medicare vs Medicare Advantage Beneficiaries","volume":"2","author":"Schwartz M. L.","year":"2019","journal-title":"JAMA Network Open"},{"issue":"1","key":"e_1_2_12_20_1","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1377\/hlthaff.2017.0714","article-title":"Medicare Advantage Enrollees More Likely to Enter Lower\u2010Quality Nursing Homes Compared to Fee\u2010for\u2010Service Enrollees","volume":"37","author":"Meyers D. J.","year":"2018","journal-title":"Health Affairs"},{"issue":"2","key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.37765\/ajmc.2026.89884","article-title":"Medicare Advantage in the US Mainland and Puerto Rico","volume":"32","author":"Chou L. 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K.","year":"2018","journal-title":"Health Services Research"},{"key":"e_1_2_12_24_1","unstructured":"U.S. Department of Agriculture \u201cRural\u2010Urban Continuum Codes \u201d updated December 30 2025 accessed January 9 2026 https:\/\/www.ers.usda.gov\/data\u2010products\/rural\u2010urban\u2010continuum\u2010codes."},{"key":"e_1_2_12_25_1","volume-title":"Medicare Advantage and Part D Star Ratings","author":"Centers for Medicare & Medicaid Services","year":"2026"},{"key":"e_1_2_12_26_1","unstructured":"Centers for Medicare & Medicaid Services \u201cMA State\/County Penetration \u201d updated September 10 2025 accessed January 9 2026 https:\/\/www.cms.gov\/data\u2010research\/statistics\u2010trends\u2010and\u2010reports\/medicare\u2010advantagepart\u2010d\u2010contract\u2010and\u2010enrollment\u2010data\/ma\u2010state\/county\u2010penetration."},{"key":"e_1_2_12_27_1","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making Neighborhood Disadvantage Metrics Accessible: The Neighborhood Atlas","volume":"378","author":"Kind A. 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C.","year":"2009","journal-title":"Statistics in Medicine"},{"issue":"3","key":"e_1_2_12_31_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.1762","article-title":"Trends in Use of Low\u2010Value Care in Traditional Fee\u2010for\u2010Service Medicare and Medicare Advantage","volume":"4","author":"Park S.","year":"2021","journal-title":"JAMA Network Open"},{"issue":"9","key":"e_1_2_12_32_1","article-title":"Comparison of Low\u2010Value Services Among Medicare Advantage and Traditional Medicare Beneficiaries","volume":"3","author":"Boudreau E.","year":"2022","journal-title":"Journal of the American Medical Association Health Forum"},{"issue":"6","key":"e_1_2_12_33_1","doi-asserted-by":"crossref","first-page":"986","DOI":"10.3122\/jabfm.2023.230123R2","article-title":"A Cluster Analysis of Initial Primary Care Orders for Patients With Acute Low Back Pain","volume":"36","author":"Joyce C. T.","year":"2024","journal-title":"Journal of American Board of Family Medicine"},{"issue":"9","key":"e_1_2_12_34_1","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1016\/j.jacr.2016.06.008","article-title":"ACR Appropriateness Criteria Low Back Pain","volume":"13","author":"Patel N. D.","year":"2016","journal-title":"Journal of the American College of Radiology"},{"key":"e_1_2_12_35_1","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1111\/1475-6773.12301","article-title":"Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations With Future Health Care Utilization and Charges","volume":"50","author":"Fritz J. M.","year":"2015","journal-title":"Health Services Research"},{"key":"e_1_2_12_36_1","doi-asserted-by":"crossref","DOI":"10.5888\/pcd18.200352","article-title":"Rural, Suburban, and Urban Differences in Chronic Pain and Coping Among Adults in North Carolina: 2018 Behavioral Risk Factor Surveillance System","volume":"18","author":"Rafferty A. P.","year":"2021","journal-title":"Preventing Chronic Disease"},{"key":"e_1_2_12_37_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2022.114788","article-title":"Rurality and Opioid Prescribing Rates in U.S. Counties From 2006 to 2018: A Spatiotemporal Investigation","volume":"296","author":"Sun F.","year":"2022","journal-title":"Social Science & Medicine"},{"issue":"10","key":"e_1_2_12_38_1","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1016\/j.apmr.2022.04.016","article-title":"Outcomes of Telehealth Physical Therapy Provided Using Real\u2010Time, Videoconferencing for Patients With Chronic Low Back Pain: A Longitudinal Observational Study","volume":"103","author":"Fritz J. 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