Transcript Spine Topic Update slides

Spine/Low Back Pain
Topic Update
January 31, 2013
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Two Tracks
1. Spine SCOAP
 In October 2012, Bree Collaborative unaminously
approved Spine SCOAP proposal: “Establish participation
in Spine SCOAP as a community standard, starting with
hospitals performing spine surgery”
 Next Step – send recommendation to HCA
2. Spine/Low Back Pain Workgroup
 Established to identify and recommend strategies for
appropriate identification and management of acute low
back pain
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Spine/Low Back Pain
Workgroup Update
Overview
 Have met twice since the last Bree Collaborative
meeting (3 meetings total)
 RECAP – Focus on preventing transition from acute to
chronic pain, as requested by the Bree Collaborative
 More specifically, focus on identifying high-cost patients
as early as possible with comprehensive assessment
that includes psychosocial screening
 At last meeting, agreed on a general outline for the
report – based on the organization of the Bree
Collaborative’s Obstetrics report
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General Approach
1. Recommend adoption of evidence-based guidelines
2. Identify modalities that are over-used in treatment of
low back pain in WA
3. Identify best practices that would lead to
appropriate/reduced use of those modalities, which will
include some patient and provider education strategies
Recognize that it is important to avoid a “one size fits all”
approach and try to highlight diverse initiatives that can be
implemented in a broad range of settings
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Proposals Currently
Under Consideration
 Support the widespread adoption of ACP/APS
guidelines in primary care settings in WA
 ACP/APS guidelines recommended by Oregon’s
Evidence-based Clinical Guidelines Project in 2011
 Only guidelines related to Lumbar MRI that the Advanced
Imaging Management Group rated as good in all 3
categories in its 2009 report
 Use the possible causes and key features from the
ACP/APS guidelines to define “red flags”
 Guidelines include a summary table
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Staff Goals in Advance of
February Meeting
 Compile material about promising initiatives including
decision support tools
 Identify areas of over-use and try to find data to serve
as a baseline measure
 May also want to find data about use of best practices
(such as physiatrist visits) so we have baseline measures
for things that we would like to see used more
 Any recommended data sources?
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Initiatives Currently
Under Review
 Virginia Mason Back Pain Collaborative
 Intel Program in Oregon (modeled after VMMC)
 STarT Back Tool
 University of Washington System
 COHE Program
 Spine SCOAP & Spine Tango
 Project ECHO
 Imaging Controls at VMMC & Everett Clinic
 Programs at Kaiser and University of Michigan
Any others that we should consider?
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Questions? Comments?
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