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Spine/Low Back Pain Topic Update

Spine/Low Back Pain Topic Update. January 31, 2013. Two Tracks. Spine SCOAP In October 2012, Bree Collaborative unaminously approved Spine SCOAP proposal: “Establish participation in Spine SCOAP as a community standard, starting with hospitals performing spine surgery”

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Spine/Low Back Pain Topic Update

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  1. Spine/Low Back Pain Topic Update January 31, 2013

  2. Two Tracks • Spine SCOAP • In October 2012, Bree Collaborative unaminously approved Spine SCOAP proposal: “Establish participation in Spine SCOAP as a community standard, starting with hospitals performing spine surgery” • Next Step – send recommendation to HCA • Spine/Low Back Pain Workgroup • Established to identify and recommend strategies for appropriate identification and management of acute low back pain

  3. Spine/Low Back Pain Workgroup Update

  4. Overview • Have met twice since the last Bree Collaborative meeting (3 meetings total) • RECAP – Focus on preventing transition from acute to chronic pain, as requested by the Bree Collaborative • More specifically, focus on identifying high-cost patients as early as possible with comprehensive assessment that includes psychosocial screening • At last meeting, agreed on a general outline for the report – based on the organization of the Bree Collaborative’s Obstetrics report

  5. General Approach • Recommend adoption of evidence-based guidelines • Identify modalities that are over-used in treatment of low back pain in WA • Identify best practices that would lead to appropriate/reduced use of those modalities, which will include some patient and provider education strategies Recognize that it is important to avoid a “one size fits all” approach and try to highlight diverse initiatives that can be implemented in a broad range of settings

  6. Proposals Currently Under Consideration • Support the widespread adoption of ACP/APS guidelines in primary care settings in WA • ACP/APS guidelines recommended by Oregon’s Evidence-based Clinical Guidelines Project in 2011 • Only guidelines related to Lumbar MRI that the Advanced Imaging Management Group rated as good in all 3 categories in its 2009 report • Use the possible causes and key features from the ACP/APS guidelines to define “red flags” • Guidelines include a summary table

  7. Staff Goals in Advance of February Meeting • Compile material about promising initiatives including decision support tools • Identify areas of over-use and try to find data to serve as a baseline measure • May also want to find data about use of best practices (such as physiatrist visits) so we have baseline measures for things that we would like to see used more • Any recommended data sources?

  8. Initiatives Currently Under Review • Virginia Mason Back Pain Collaborative • Intel Program in Oregon (modeled after VMMC) • STarT Back Tool • University of Washington System • COHE Program • Spine SCOAP & Spine Tango • Project ECHO • Imaging Controls at VMMC & Everett Clinic • Programs at Kaiser and University of Michigan Any others that we should consider?

  9. Questions? Comments?

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