text: In future studies, we will embed the OSPRO tools into 
  electronic medical record (EMR) databases to refine and 
  test outcomes prediction models at the health care systems 
  level. Importantly, we will collect clinical encounter data 
  through the EMR and combine it with administrative or 
  billing data to confirm the results of this study with more 
  objective measures of health care use. These studies will 
  also allow us to provide better guidance on how to use the 
  OSPRO tools to identify serious psychiatric involvement or 
  systemic sources of pain that require medical referral. Fi- 
  nally, we will explore alternative scoring strategies for the 
  tools, such as weighted scoring for the OSPRO-ROS and 
  use of predicted full-length psychological questionnaire 
  scores for the OSPRO-YF. Healthcare providers could then 
  use the collective information from these studies to build 
  learning health systems that facilitate effective, real-time 
  clinical decision-making support to improve value of care 
  for patients with musculoskeletal pain. 
  
  Conclusion 
  Baseline disability and change in pain intensity were im- 
  portant predictors of 
  subsequent pain-related 
  any 
  healthcare utilization, while predictors of individual ser- 
  vice utilization were outcome-specific. Identification of 
  risk is improved through treatment monitoring for pain 
  and, in some cases, disability and pain-related psycho- 
  logical distress. Comorbidity burden was an important 
  predictor of subsequent utilization of opioids and diag- 
  nostic tests and imaging, both of which have been recent 
  targets of healthcare policy to constrain their unneces- 
  sary use. Future research is needed to refine these pre- 
  dictor variables and incorporate them into risk models 
  that support clinical decision-making so that treatment 
  effectiveness and efficiency are optimized in value-based 
  systems. 
  
  the clinical encounter might 
  
  Third, we were unable to adequately model the spe- 
  cific effects of worker’s compensation, self-pay and some 