In 2009 an acute low back treatment program was piloted in primary care. The intent of the program was to decrease early use of imaging, opioids, referral for specially evaluation and intervention while at the same time encouraging early use of physical therapy. Components of the program included standardized EMR-based documentation tools, order writing and patient education tools. The program included education and coordination with physical therapists to whom the patients were to be referred. It also included a feedback mechanism of performance reports to the providers and their leaders. This process involved the identification of low back cases by ICD-9 codes. A limitation of ICD-9 coding is that it does not allow differentiation of acute versus chronic low back pain. Given this a grant was applied for and awarded on the basis of the following aims.
Aim 1: Among a sample of acute low back pain patients at 9 clinics, conduct chart audits to determine the proportion who have 1) acute non-recurrent pain, 2) acute recurrent pain, 3) chronic back pain.
Aim 2: Describe changes in patient care in these same 9 clinics, among patients identified in categories 1) and 2) in Aim 1 in terms of proportions of such patients receiving: 1) imaging orders, 2) surgery referral, 3) injection referral), 4) prescriptions for narcotics, prior to and following implementation of the program.
Aim 3: Describe the proportion of patients identified in categories 1) and 2) in Aim 1 in each clinic who receive standard education about low back pain following implementation of the program.
Results: Of the 900 cases selected 880 were included in the sample for analysis. Of these 318 cases were identified as acute and 160 cases acute recurrent. For aims one and two please see tables A and B. Groups one and two showed no significant difference in the distribution of acute, acute recurrent or chronic pain. There was no statistically significant impact of the intervention on frequency of imaging, use of narcotics, injection referral, surgery referral for either acute or acute recurrent groups or in the aggregate. Physical therapy referral showed a P. value of 0.0274 acute recurrent cases only. There was no change in the aggregate or in the acute group.