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. 2000 Sep;15(9):647-55.
doi: 10.1046/j.1525-1497.2000.90717.x.

Continuous quality improvement for patients with back pain

R A Deyo  1 , M Schall, D M Berwick, T Nolan, P Carver
Affiliations

Continuous quality improvement for patients with back pain

R A Deyo et al. J Gen Intern Med. 2000 Sep.

Abstract

Recent evidence has changed traditional approaches to low back pain, suggesting minimal bed rest, highly selective imaging, and early return to normal activities. However, there are wide geographical variations in care, and substantial gaps between practice and evidence. This project sought to merge scientific evidence about back pain and knowledge about behavior change to help organizations improve care for back pain. Participating insurance plans, HMOs, and group practices focused on problems they themselves identified. The year-long program included quarterly meetings, coaching for rapid cycles of change, a menu of potential interventions, and recommendations for monitoring outcomes. Participants interacted through meetings, e-mail, and conference calls. Of the 22 participating organizations, 6 (27%) made major progress. Typical changes were reduced imaging, bed rest, and work loss, and increased patient education and satisfaction. Specific examples were a 30% decrease in plain x-rays, a 100% increase in use of patient education materials, and an 81% drop in prescribed bed rest. Despite the complexity of care for back pain, rapid improvements appear feasible. Several organizations had major improvements, and most experienced at least modest improvements. Key elements of successful programs included focus on a small number of clinical goals, frequent measurement of outcomes among small samples of patients, vigilance in maintaining gains; involvement of office staffs as well as physicians, and changes in standard protocols for imaging, physical therapy, and referral.

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Figures

FIGURE 1
FIGURE 1
Selected measures of process and outcome in 1 intervention clinic. Data are plotted for 2 baseline months and 7 months of intervention. Data are based on recurrent samples of approximately 10 patients for each month.
FIGURE 2
FIGURE 2
Selected process and outcome measures for a large insurance plan. Data are plotted for 1 baseline month and 7 months of intervention. Data are based on recurrent samples of 10 to 25 patients per month.
See this image and copyright information in PMC

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