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Rapid improvements in lower back care possible

Hospitals and other health care organizations may be capable of reasonably quick and efficient improvements in the way they treat lower back pain, suggest the results of a recent study.

Such changes are advised, as official guidelines for lower back pain treatment have changed in recent years. Current recommendations include minimal bed rest, selective use of imaging tests and surgery, and a speedy return to everyday activities.

However, a large gap exists between these recommendations and common practice. Lengthy bed rest is still widely prescribed, and as much as 60 percent of prescribed imaging tests, including x-rays and MRIs, may be unnecessary, according to the study.

At the prompting of the Institute for Healthcare Improvement, an independent nonprofit organization based in Boston, a group of 22 health care organizations agreed to implement changes to improve lower back pain treatment.

"Rather than identifying 'bad apples,' the intent is to improve the performance of all providers in a system," said lead author Richard A. Deyo, MD.

"Our goal was to facilitate improvement in care for back pain in large organizations, focusing on problems they themselves identified," said Deyo, of the University of Washington, Seattle.

According to Deyo and colleagues from the Institute for Healthcare Improvement the ideal way to treat lower back pain involves extensive use of patient education and self-care and more of an emphasis on exercise therapy than on diagnostic imaging tests.

To improve their lower back treatment, teams representing the participating organizations -- which included HMOs, an academic medical center, a chiropractic college, and large hospital-based practices -- were taught the latest quality-improvement strategies.

Team members were coached to work together in setting goals, monitoring their progress, and initiating rapid changes that would later be refined for wider implementation.

Deyo and colleagues found tha
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Contact: Richard A. Deyo, MD
deyo@u.washington.edu
206-616-5360
Center for the Advancement of Health
31-Aug-2000


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