SPINE20 A global advocacy group promoting evidence-based spine care of value

Aleissa, Sami; Tamai, Katsuto; Konbaz, Faisal; Alturkistany, Ahmed; Blattert, T. R.; Chhabra, Harvinder Singh; Costanzo, Giuseppe; Dohring, Edward J.; Kandziora, Frank; Kothe, Ralph; Misaggi, Bernardo; Muehlbauer, Eric J.; Pereira, Paulo; Rajasekaran, Shanmuganathan; Sullivan, William J.; Truumees, Eeric; Alqahtani, Yahya; Alsobayel, Hana; Franke, Jöerg; Teli, Marco; Wang, Jeffrey C.; Al-Hazzaa, Hazzaa M.; Alosaimi, Majed; Berven, Sigurd; Brayda-Bruno, Marco; Briggs, Andrew M.; Busari, Jamiu O; Caserta, Antonello; Côté, Pierre; Crostelli, Marco; Fehlings, Michael G.; Gunzburg, Robert; Haddadin, Sami; Ihm, Joseph; Hilibrand, Alan S.; Luca, Andrea De; Mazza, Oscar; Pigott, Tim; Rothenfluh, Dominique A.; Ruosi, Carlo; Salmi, Louis Rachid; Shetty, Ajoy Prasad; Singh, Kern; Vaccaro, Alexander R.; Wong, David A.; Zılelı, Mehmet; Nordin, Margareta

doi:10.1007/s00586-021-06890-5

Cited by 17 publications

(15 citation statements)

References 27 publications

(32 reference statements)

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Section: Introductionmentioning

confidence: 99%

“…Health care policymakers, payors, professional societies, and other key stakeholders are seeking to implement strategies that improve the value of care for musculoskeletal disorders [1, 2]. Among musculoskeletal conditions, low back pain (LBP) causes the highest disease burden [1]. In the United States (US), 67% of individuals with LBP seek care annually [3], and LBP is the second most common reason for visiting a primary care provider [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low back pain care pathways and costs: association with the type of initial contact health care provider. A retrospective cohort study

Elton

Kosloff

Zhang

et al. 2022

Preprint

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BackgroundLow back pain (LBP) is prevalent, management benefits from high-quality clinical practice guidelines, and yet LBP is a common source of low value care. The purpose of this retrospective cohort study was to examine the association between the type of initial contact health care provider (HCP), service utilization, and total episode cost for the management of LBP.MethodsEpisode of care was used to analyze a US national sample of LBP episodes completed in 2017-2019. A combined surgical and non-surgical (pooled) sample and a non-surgical sample were separately analyzed. The primary independent variable was the type of the initial contact HCP. Dependent measures included rate and timing of use of 14 types of health care services and total episode cost. The association between initial contact HCP, total episode cost and rate of prescription opioid and NSAID use was tested using a mixed effects model.ResultsThe study included 616,766 continuously insured individuals aged 18 years and older with 756,631 episodes of LBP involving 386,795 HCPs and incurring $1,010,495,291 in expenditures. A primary care or specialist HCP was initially contacted in 62.0% of episodes, with these episodes associated with early use of low-value services such as imaging, pharmacologic, and interventional services. A non-prescribing HCP was initially contacted in 32.5% of episodes with these episodes associated with early use of guideline recommended first line services. Each type of HCP emphasized different initial services with little indication of a stepped approach to managing LBP. Following adjustment for covariates chiropractors were associated with the lowest total episode cost. As an observational study of associations, numerous confounders may have impacted results.ConclusionsAn individual with LBP has different experiences based on the type of HCP initially contacted. Initial contact with primary care or specialist HCPs is associated with second- and third-line services provided before first line services, with little indication of a guideline recommended stepped approach to managing LBP. Increasing the likelihood of guideline-concordant, high-value care for LBP may require systemic changes to the health care delivery system. In the absence of red flags these changes may include increasing the proportion of individuals receiving early non-pharmacological treatment, either through improving direct access to non-prescribing HCPs or increasing timely referrals from primary care and specialist health care providers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low back pain care pathways and costs: association with the type of initial contact health care provider. A retrospective cohort study

Elton

Kosloff

Zhang

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…LBP is the source of a high proportion of “low-value” care, described as services generating costs without or with minimal beneficial impact on outcomes 8,9 . Examples of low-value care for LBP include overuse of imaging, interventional procedures, and some prescription medications such as opioids 10-13 . Management of LBP that is not concordant with CPGs is associated with the risk of LBP transitioning from an acute to a chronic condition 14 .…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Examples of low-value care for LBP include overuse of imaging, interventional procedures, and some prescription pharmaceuticals such as opioids. 10-13 Management of LBP that is not concordant with CPGs is associated with the risk of LBP transitioning from an acute to a chronic condition. 14…”

Section: Introductionmentioning

confidence: 99%

Low back pain service utilization and costs: association with timing of first-line services for individuals initially contacting a primary care provider. A retrospective cohort study

Elton

Zhang

2022

Preprint

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Background: Low back pain (LBP) is prevalent, costly, and a common reason for a visit to a primary care provider (PCP). Guidelines recommend a stepped approach to management. Objective: For individuals with LBP initially contacting a PCP, examine the association between the incorporation of first-line therapies, use of second- and third-line services and total episode cost. Design: Retrospective cohort study Setting/Patients: National sample of individuals with non-surgical LBP occurring in 2017-2019. Measurements: Independent variables were initial contact with a PCP, and the timing of incorporation of 5 types of first-line therapies. Dependent measures included use of 14 types of health care services and total episode cost. Results: 8.5% of 118,503 PCPs initially contacted by 308,790 individuals with 347,627 episodes of non-surgical LBP were associated with an episode including any first-line service at any time. 17.5% of episodes included any first-line service at any time. Active care (11.6% of episodes), manual therapy (8.0%) and chiropractic manipulative therapy (7.0%) were the most common first line services. 5.4% of episodes included a first-line service during the first 7 days. These episodes were associated with a modest reduction in the use of prescription pharmaceuticals, with no impact on the use of imaging or spinal injection. First-line services were associated with an increase in total episode cost with the smallest increase associated with chiropractic and osteopathic manipulation. Younger individuals from ZIP codes with higher adjusted gross income were more likely to receive a first-line service in the first 7 days of an episode. Limitations: As a retrospective observational analysis of associations there are numerous potential confounders and limitations. Conclusions: Individuals with non-surgical LBP initially contacting a PCP infrequently receive a first-line service, and if received, it is typically in addition to second- and third-line pharmaceutical, imaging, and interventional services. There is an opportunity to improve concordance with the stepped approach to management described in LBP guidelines.

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“…The main goal of SPINE20 is to develop evidence-based policy recommendations for the G20 governments to reduce the burden of spine disorders, disability, and injuries. [7,8] The recommendations are intended to benefit individuals with spine disorders, benefiting the community and, ultimately, the country. Countries have different abilities to implement recommendations depending on their geographical location and wealth.…”

Section: Introductionmentioning

confidence: 99%

SPINE20 recommendations 2022: spine care—working together to recover stronger

Darwono¹,

Tamai

Côté

et al. 2022

Eur Spine J

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Purpose Globally, spine disorders are the leading cause of disability, affecting more than half a billion individuals. However, less than 50% of G20 countries specifically identify spine health within their public policy priorities. Therefore, it is crucial to raise awareness among policy makers of the disabling effect of spine disorders and their impact on the economic welfare of G20 nations. In 2019, SPINE20 was established as the leading advocacy group to bring global attention to spine disorders. Methods Recommendations were developed through two Delphi methods with international and multi-professional panels. Results In 2022, seven recommendations were delivered to the leaders of G20 countries, urging them to: Develop action plans to provide universal access to evidence-based spine care that incorporates the needs of minorities and vulnerable populations. Invest in the development of sustainable human resource capacity, through multisectoral and inter-professional competency-based education and training to promote evidence-based approaches to spine care, and to build an appropriate healthcare working environment that optimizes the delivery of safe health services. Develop policies using the best available evidence to properly manage spine disorders and to prolong functional healthy life expectancy in the era of an aging population. Create a competent workforce and improve the healthcare infrastructure/facilities including equipment to provide evidence-based inter-professional rehabilitation services to patients with spinal cord injury throughout their continuum of care. Build collaborative and innovative translational research capacity within national, regional, and global healthcare systems for state-of-the-art and cost-effective spine care across the healthcare continuum ensuring equality, diversity, and inclusion of all stakeholders. Develop international consensus statements on patient outcomes and how they can be used to define and develop pathways for value-based care. Recognize that intervening on determinants of health including physical activity, nutrition, physical and psychosocial workplace environment, and smoking-free lifestyle can reduce the burden of spine disabilities and improve the health status and wellness of the population. At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations. Conclusion SPINE20 advocacy efforts focus on developing public policy recommendations to improve the health, welfare, and wellness of all who suffer from spinal pain and disability. We propose that focusing on facilitating access to systems that prioritize value-based care delivered by a competent healthcare workforce will reduce disability and improve the productivity of the G20 nations.

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SPINE20 A global advocacy group promoting evidence-based spine care of value

Cited by 17 publications

References 27 publications

Low back pain care pathways and costs: association with the type of initial contact health care provider. A retrospective cohort study

Low back pain care pathways and costs: association with the type of initial contact health care provider. A retrospective cohort study

Low back pain service utilization and costs: association with timing of first-line services for individuals initially contacting a primary care provider. A retrospective cohort study

SPINE20 recommendations 2022: spine care—working together to recover stronger

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