Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care

Ivanova, Jasmina I.; Birnbaum, Howard G.; Schiller, M.; Kantor, Evan; Johnstone, Bryan M.; Swindle, Ralph

doi:10.1016/j.spinee.2011.03.017

Cited by 251 publications

(208 citation statements)

References 27 publications

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“…Cost estimates vary, but the most recent estimates (2008) put care related to back pain at $86 billion in incremental health care costs. 17 A 49% increase in the number of patients seeking spine-related care (from 12.2 million in 1997 to 18.2 million in 2006) was the largest contributing factor to increased outpatient expenditures. 18 Adding to the problem is a sharp increase in the number of investigations and interventions performed related to back pain, including imaging, injections, surgical procedures, implantable devices, and medications.…”

Section: Back Pain-an Overviewmentioning

confidence: 99%

“…Although each new CPG may emphasize a distinct aspect of care or a specific subgroup, the collective recommendations have been largely consistent, with only minor changes throughout the years based on new evidence. 17,30 Among these guidance documents, there was general agreement on 5 main sequential goals when conducting an assessment of LBP:…”

Section: Review Of Clinical Practice Guidelines For Low Back Painmentioning

confidence: 99%

“…A recently published analysis of nationwide private insurer claims covering more than 8 million lives revealed the frontloading of treatment expenditures, even among patients with nonspecific LBP. 17 ''Contrary to clinical guidelines, many patients with low back pain start incurring significant resource use and associated expenses soon after the index [initial] diagnosis.'' 17, p.623 The analysis showed:…”

Section: Current Clinical Practicesmentioning

confidence: 99%

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Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

Kosloff

Elton

Shulman

et al. 2013

Population Health Management

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Low back pain (LBP) has received considerable attention from researchers and health care systems because of its substantial personal, social, work-related, and economic consequences. A narrative review was conducted summarizing data about the epidemiology, care seeking, and utilization patterns for LBP in the adult US population. Recommendations from a consensus of clinical practice guidelines were compared to findings about the current state of clinical practice for LBP. The impact of the first provider consulted on the quality and value of care was analyzed longitudinally across the continuum of episodes of care. The review concludes with a description of recently published evidence that has demonstrated that favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care pathways. (Population Health Management 2013;16:390-396)

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Section: Back Pain-an Overviewmentioning

confidence: 99%

Section: Review Of Clinical Practice Guidelines For Low Back Painmentioning

confidence: 99%

Section: Current Clinical Practicesmentioning

confidence: 99%

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Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

Kosloff

Elton

Shulman

et al. 2013

Population Health Management

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“…[1][2][3] Patients seeking primary care for low back pain often receive x-rays and other imaging studies, but such imaging rarely improves care and can incur unnecessary radiation exposure and costs. [4][5][6][7][8][9][10][11][12] Several national quality guidelines recommend that clinicians not order imaging tests for nonspecific low back pain. One Clinical Quality Measure (CQM) that is a metric of "Meaningful Use" of electronic health records (EHR), per the Centers for Medicare and Medicaid Services (CMS), is "Percentage of patients with a primary diagnosis of low back pain who did not have an imaging study ... within 28 days of diagnosis."…”

Section: Introductionmentioning

confidence: 99%

“…15 Nevertheless, clinical practice often diverges from these guidelines. 10 In data representing 440 million visits for spine-related care, 17% were associated with subsequent radiography. 11 Research suggests possible reasons for this guideline-discordant care.…”

Section: Introductionmentioning

confidence: 99%

Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis

Gold

Esterberg

Hollombe

et al. 2016

TPJ

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Application of “Less Is More” to Low Back Pain

2012

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An initiative of the National Physicians Alliance, the project titled "Promoting Good Stewardship in Clinical Practice," developed a list of the top 5 activities in primary care for which changes in practice could lead to higher-quality care and better use of finite clinical resources. One of the top 5 recommendations was "Don't do imaging for low back pain within the first 6 weeks unless red flags are present." This article presents data that support this recommendation. We selectively reviewed the literature, including recent reviews, guidelines, and commentaries, on the benefits and risks of routine imaging in low back pain. In particular, we searched PubMed for systematic reviews or meta-analyses published in the past 5 years. We also assessed the cost of spine imaging using data from the National Ambulatory Medical Care Survey. One high-quality systematic review and meta-analysis focused on clinical outcomes in patients with low back pain and found no clinically significant difference in pain or function between those who received immediate lumbar spine imaging vs usual care. Published data also document harms associated with early imaging for low back pain, including patient "labeling," unneeded follow-up tests for incidental findings, irradiation exposure, unnecessary surgery, and significant cost. Routine imaging should not be pursued in acute low back pain. Not imaging patients with acute low back pain will reduce harms and costs, without affecting clinical outcomes.

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Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care

Cited by 251 publications

References 27 publications

Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis

Application of “Less Is More” to Low Back Pain

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