1 / 11

The Bree Collaborative’s Role in Spine/Low Back Pain Care: A Proposal

The Bree Collaborative’s Role in Spine/Low Back Pain Care: A Proposal. Presentation to the Bree Collaborative August 2, 2012. Purpose of Presentation .

geona
Download Presentation

The Bree Collaborative’s Role in Spine/Low Back Pain Care: A Proposal

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The BreeCollaborative’s Role in Spine/Low Back Pain Care:A Proposal Presentation to the Bree Collaborative August 2, 2012

  2. Purpose of Presentation • Present proposed approach for Bree’s role in Spine care/Low Back Pain topic -where Bree can add value, improve outcomes, and reduce costs • Discuss and adopt general approach

  3. Experts met July 2nd Invited Participants • Gary Franklin, MD, L&I • Leah Hole-Curry, L&I • Vickie Kolios-Morris, Spine SCOAP, FHCQ • Mary Kay O’Neill, MD, Cigna • John Robinson, MD, First Choice Health • Terry Rogers, MD, FHCQ Invited guest • Rick Deyo, MD, OHSU Staff: Steve Hill & Rachel Quinn

  4. Low Back Pain is common, costly, and complex • One of the most common reasons for patients to see physicians • Leading cause of work-related disability and workers’ compensation for people under age 45 • Medical costs are in excess of $25 billion per year; commercially, musculoskeletal top expenditure • There’s a huge psycho/social element to low back pain - one of the strongest predictors of onset of low back pain and transition from acute to chronic is patient’s emotional status and presence of work-life issues

  5. Variation in Treatment and Management among Patients with Acute and Chronic Back Pain Acute/Subacute(symptoms lasting less than 12 weeks) • Unnecessary use of imaging and surgery without improved outcomes • Patients seen by wide variety of practitioners with different treatment approaches • Most acute & subacute low back pain patients could be managed and screened in outpatient primary care setting Chronic(symptoms lasting more than 12 weeks) • Huge variability in lumbar fusion surgeries, and they are very expensive

  6. Bree and History of Spine Care Presentations/discussons to date, at 3 Bree Collaborative meetings, have focused on lumbar spinal fusions – treatment for chronic, not acute back pain • September 30, 2011 • January 30, 2012 • March 29, 2012

  7. Bree Topic Goals & Guidelines • Goal: • Improve quality, outcomes for patients and cost-effectiveness  • Topic Selection • Significant safety, efficacy or cost-effectiveness concerns  • Substantial variation in practice patterns or high utilization trends can be indicators of poor quality and potential waste in the health care system, without producing better care outcomes  • Outcome: • Identify topics with variation or quality concerns, and recommend evidence-based strategies to improve quality and cost-effectiveness Yes, both acute and chronic spine care fit criteria

  8. Low Back Pain Initiatives in WA UW Comparative Effectiveness Research Pilot on lumbar fusions and spine care in general ACUTE (< 6 weeks) CHRONIC ( > 3 months) Spine SCOAP compiles data on all spine surgeries

  9. Recommendations • Create a spine subgroup • Initial focus of spine workgroup: how to appropriately manage patients with acute low back pain, and prevent transition of acute/subacute to chronic low back pain • Gather evidence-based guidelines, emerging best practices & data on how to appropriately manage acute • St. Joseph’s, Virginia Mason Medical Center • Institute for Clinical Systems Improvement (ICSI) • Evidence-based business practices (Intel/Oregon program) • Centers of Occupational Health & Education (COHE) • Gather education of alternatives (shared decision aids) • How to support/align with existing efforts, whether focus is acute or chronic (e.g., comparative effectiveness registry)

  10. Recommendation: Spine Subgroup • Members of exploratory group • Gary Franklin • Mary Kay O’Neill • John Robinson • Subgroup recommendations • Bob Moots, associate director for chiropractics, L&I • A spine surgeon • Others?

  11. Recommendation: Registry Subgroup to consider the following recommendation: • All hospitals and ASCs (that perform discectomy, fusion, and/or disc replacement) participate in a publicly reported, prospective, benchmarking registry of spine surgical and interventional procedures • Participation in such a registry will generate needed information about the appropriateness of surgical/intervention spine care that can be used to support future HTA and payer decisions related to spine care. • The registry should focus its public reporting on progress in reducing variation in the use of less indicated procedures, as well as in improving the quality, effectiveness and cost-effectiveness of care.

More Related