Hospitals and other health care organizations may be capable of reasonably quick and efficient improvements in the way they treat lower back pain, suggest the results of a recent study.
Such changes are advised, as official guidelines for lower back pain treatment have changed in recent years. Current recommendations include minimal bed rest, selective use of imaging tests and surgery, and a speedy return to everyday activities.
However, a large gap exists between these recommendations and common practice. Lengthy bed rest is still widely prescribed, and as much as 60 percent of prescribed imaging tests, including x-rays and MRIs, may be unnecessary, according to the study.
At the prompting of the Institute for Healthcare Improvement, an independent nonprofit organization based in Boston, a group of 22 health care organizations agreed to implement changes to improve lower back pain treatment.
"Rather than identifying 'bad apples,' the intent is to improve the performance of all providers in a system," said lead author Richard A. Deyo, MD.
"Our goal was to facilitate improvement in care for back pain in large organizations, focusing on problems they themselves identified," said Deyo, of the University of Washington, Seattle.
According to Deyo and colleagues from the Institute for Healthcare Improvement the ideal way to treat lower back pain involves extensive use of patient education and self-care and more of an emphasis on exercise therapy than on diagnostic imaging tests.
To improve their lower back treatment, teams representing the participating organizations -- which included HMOs, an academic medical center, a chiropractic college, and large hospital-based practices -- were taught the latest quality-improvement strategies.
Team members were coached to work together in setting goals, monitoring their progress, and initiating rapid changes that would later be refined for wider implementation.
Deyo and colleagues found that 27 percent of the organizations made major progress toward attaining their chosen goals over the one-year study period, and most of the remaining organizations saw modest improvement.
One organization decreased diagnostic x-rays by 30 percent, another increased the use of patient education materials by 100 percent, and a third reduced prescriptions for bed rest by 81 percent. The study findings are published in the September issue of the Journal of General Internal Medicine.
"These experiences suggest that rapid improvements in care for back pain are difficult but feasible," noted Deyo. "Although only 27 percent of the participating organizations posted major improvements, this can be seen as a substantial gain over the status quo."
Also, it's an improvement over previous educational efforts directed solely at physicians or at patients, which had limited success, according to the study.
Making long-term changes to lower back pain care is expensive and time consuming and requires significant commitment to ensure previous gains aren't reversed.
"If more widely implemented, such improvements might help reverse the unnecessarily large impact of back pain on patients, health care costs, and employers," Deyo concluded.
This research was sponsored by the Institute for Healthcare Improvement.
The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org (202) 387-2829.
Journal
Journal of General Internal Medicine