Continuous quality improvement for patients with back pain

Richard (Rick) Deyo, Marie Schall, Donald M. Berwick, Tom Nolan, Penny Carver

Research output: Contribution to journalArticle

17 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)647-655
Number of pages9
JournalJournal of General Internal Medicine
Volume15
Issue number9
DOIs
StatePublished - 2000
Externally publishedYes

Fingerprint

Bed Rest
Back Pain
Quality Improvement
Organizations
Patient Education
Group Practice
Health Maintenance Organizations
Postal Service
Low Back Pain
Insurance
Patient Satisfaction
Referral and Consultation
X-Rays
Physicians
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Continuous quality improvement for patients with back pain. / Deyo, Richard (Rick); Schall, Marie; Berwick, Donald M.; Nolan, Tom; Carver, Penny.

In: Journal of General Internal Medicine, Vol. 15, No. 9, 2000, p. 647-655.

Research output: Contribution to journalArticle

Deyo, Richard (Rick) ; Schall, Marie ; Berwick, Donald M. ; Nolan, Tom ; Carver, Penny. / Continuous quality improvement for patients with back pain. In: Journal of General Internal Medicine. 2000 ; Vol. 15, No. 9. pp. 647-655.
@article{0f077dc5b86e47e2971acd8fa8af7b84,
title = "Continuous quality improvement for patients with back pain",
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.",
author = "Deyo, {Richard (Rick)} and Marie Schall and Berwick, {Donald M.} and Tom Nolan and Penny Carver",
year = "2000",
doi = "10.1046/j.1525-1497.2000.90717.x",
language = "English (US)",
volume = "15",
pages = "647--655",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "9",

}

TY - JOUR

T1 - Continuous quality improvement for patients with back pain

AU - Deyo, Richard (Rick)

AU - Schall, Marie

AU - Berwick, Donald M.

AU - Nolan, Tom

AU - Carver, Penny

PY - 2000

Y1 - 2000

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0033770594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033770594&partnerID=8YFLogxK

U2 - 10.1046/j.1525-1497.2000.90717.x

DO - 10.1046/j.1525-1497.2000.90717.x

M3 - Article

C2 - 11029679

AN - SCOPUS:0033770594

VL - 15

SP - 647

EP - 655

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 9

ER -