215697 A community-based and evidence-based approach to the management of low back pain: Preliminary report of outcomes data

Monday, November 8, 2010 : 5:06 PM - 5:24 PM

Ian Paskowski, DC , Medical Director, Medical Back Pain Program, Jordan Hospital, Plymouth, MA
Michael Schneider, DC, PhD Assistant Professor , School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
           
Purpose: Our community hospital developed an innovative approach to one of the most common ailments affecting the public – low back pain (LBP). We assembled our entire clinical staff and developed a multi-disciplinary team approach to the management of LBP that centered on an evidence-based clinical algorithm using standardized processes for diagnostic triage and treatment. Our goals were to improve clinical outcomes, to reduce unnecessary treatments and diagnostic testing, lower cost, and to improve patient satisfaction.

Methods: All clinicians followed standardized processes when assessing new LBP patients. Pain and disability questionnaires were administered at baseline and at discharge visits. A treatment satisfaction questionnaire was mailed to all patients after discharge. We also gathered descriptive statistics on the proportion of new LBP patients who were referred for diagnostic testing and surgical consultations.

Results: Our data have indicated significant improvements in pain and disability in the majority of our LBP patients, lowered rates of referral for diagnostic imaging, interventional spine injections, and surgery; while maintaining extremely high patient satisfaction rates.

Conclusions: Standardized processes for the management of LBP result in good clinical outcomes, while lowering cost and maintaining high patient satisfaction. Our hospital also developed a community-based outreach program to inform the public and primary care community about this evidence-based approach and guidelines for appropriate management of LBP. We believe that these standardized processes can be replicated at other clinics around the country, serving as a model for reducing the public health costs of pain and disability due to LBP.

Learning Areas:
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1.Compare the four basic subsets of low back pain according to a treatment based classification along with their appropriately matched treatments. 2.Identify the key parameters of the NCQA Back Pain Recognition Program and how they relate to standardizing processes for the management and triage of low back pain patients. 3.Discuss the role of community-based health centers in adopting evidence based standards for the management of low back pain.

Keywords: Chiropractic, Community Health Centers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because as medical director, I lead the developement and implementation of a evidence based, patient centered health care program in a community based hopsital, focused on improving the quality and standard of care for low back pain oatients in our community.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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