The back pain outcome assessment team: Background and progress

Objectives: To describe the federal initiative in outcomes research, the organization and structor of a Patient Outcomes Research Team [PORT] concerned with low back pain, and the early progress of this research team. Findings: Back pain is a leading reason for physician visits, hospitalization, and work disability. However, there is a paucity of valid evidence to support most current methods of treating spine disorders. This PORT was funded to study geographic variation in the use of back surgery and to better characterize its outcomes; evaluate the reasons for nonsurgical hospitalization for back pain; examine the accuracy and optimal sequencing of expensive diagnostic tests; and disseminate information to clinicians and patients to improve the process of care. This effort requires a multidisciplinary team of clinicans and methodologist, and a network of government and professional organizations concerned about the problem of low back pain. The team has documented wide geographic variations in rates of back surgery, and identified differences in surgical outcome according to patient age, diagnosis, and type of surgical procedure. Nonsurgical hospitalizations are declining, but remain common for inpatient myelography and pain control. The research team has provided data for an interactive computer-based videodisc to help patients with surgical decision making, and is disseminating data on practice patterns to surgeons in Washington State in an effort to reduce practice variabiltiy. Conclusions: This PORT has combined literature synthesis, administrative data, and prospective cohort studies to better define the variability and outcomes of alternative treatments for lumbar spine problems. The team is testing innovative methods for disseminating information to physicians and patients, with the hope of encouraging a more consistent and rational clinical approach.