The Bree Collaborative’s Role in Spine/Low Back Pain Care: A Proposal Presentation to the Bree...
-
Upload
michael-hoover -
Category
Documents
-
view
214 -
download
0
Transcript of The Bree Collaborative’s Role in Spine/Low Back Pain Care: A Proposal Presentation to the Bree...
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
3
Experts met July 2nd
Invited Participants• 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
4
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
5
Variation in Treatment and Management among Patients with Acute and Chronic Back PainAcute/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
6
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
7
Bree Topic Goals & Guidelines • Goal:
▫ Improve quality, outcomes for patients and cost-effectiveness
• 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
8
Low Back Pain Initiatives in WAPuget Sound
Health Alliance Low Back Pain
Clinical Improvement
Team Recommendation (2007): focus on
outpatient management of acute low back
pain
UW/Spine SCOAP conducts spine forums to discuss spine issues
WA Technology Assessment Project will not pay for fusions for
degenerative disc disease
unless failure of
multidisciplinary program
ACUTE
(< 6 weeks)
CHRONIC
( > 3 months)
Spine SCOAP compiles data on all spine surgeries
UW Comparative Effectiveness Research Pilot on lumbar fusions and spine care in general
9
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 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)
10
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?
11
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.