Transcript Spine Presentation

The Bree Collaborative’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
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Experts met July 2nd
Invited Participants
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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
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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
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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
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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
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Bree Topic Goals & Guidelines
• Goal:
▫ Improve quality, outcomes for patients and costeffectiveness
• 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
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Low Back Pain Initiatives in WA
Puget Sound
Health Alliance
Low Back Pain
Clinical
Improvement Team
Recommendation
(2007): focus on
outpatient
management of
acute low back pain
UW Comparative
Effectiveness
Research Pilot on
lumbar fusions and
spine care in general
WA
Technology
Assessment
Project will not
pay for fusions
for degenerative
disc disease
unless failure of
multidisciplinary
program
ACUTE
CHRONIC
(< 6 weeks)
( > 3 months)
Spine SCOAP compiles data on all spine surgeries
UW/Spine SCOAP conducts spine forums
to discuss spine issues
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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
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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)
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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?
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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.