Recent evidence has changed traditional approaches to low back pain, sugges
ting minimal bed rest, highly selective imaging, and early return to normal
activities. However, there are wide geographical variations in care, and s
ubstantial gaps between practice and evidence.
This project sought to merge scientific evidence about back pain and knowle
dge about behavior change to help organizations improve care for back pain.
Participating insurance plans, HMOs, and group practices focused on proble
ms they themselves identified. The year-long program included quarterly mee
tings, coaching for rapid cycles of change, a menu of potential interventio
ns, and recommendations for monitoring outcomes. Participants interacted th
rough 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 patie
nt education and satisfaction. Specific examples were a 30% decrease in pla
in 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 fea
sible. Several organizations had major improvements, and most experienced a
t least modest improvements, Key elements of successful programs included f
ocus on a small number of clinical goals, frequent measurement of outcomes
among small samples of patients, vigilance in maintaining gains; involvemen
t of office staffs as well as physicians, and changes in standard protocols
for imaging, physical therapy, and referral.