Page 14 - Delaware Medical Journal - January 2016
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Choosing Wisely in Delaware:
Rationale for Evidence-Based Diagnosis & Evaluation of Low Back Pain
L eeAnn Tanaka, DO; Omar A. Khan, MD, MHS, FAAFP;
Eric V. Jackson, MD, MBA; Kristen E. Miller, DrPH; Tze C. Chiam, PhD
IntroductionAcute low back pain (LBP), among the most common
causes of disability and lost productivity in the United States,
It is a condition with high incidence and prevalence, with the lifetime prevalence being quoted to be around 80 percent.1 Despite guidelines that diagnostic imaging is indicated for patients with Table 1), imaging for acute episodes of LBP continues to be prevalent. Studies show lumbar imaging for LBP without indications of serious underlying conditions does
not improve clinical outcomes.2 There is widespread agreement that excessive imaging leads to overdiagnosis and overtreatment of back problems, harms patients directly and indirectly, misappropriates scarce equipment, resources, and staff, and is associated with excessive costs for the patient, hospital, and payer.
possibly worse outcomes.3 In an effort to translate Choosing Wisely recommendations into performance measures using data from electronic health record systems,4 four criteria (feasibility of data projected impact) were adapted from the National Quality Forum5 to evaluate the feasibility of such translation. Of the 45 Choosing Wisely recommendations, LBP is one of the six recommended for performance measures development, which adds to the motivation of the study proposed in this paper.
The Choosing Wisely campaign, which began as a partnership among the American Board of Internal Medicine Foundation, Consumer Reports, and nine other leading medical organizations, targets the main goal of advancing discussion to avoid unnecessary and wasteful tests, treatments, and procedures. The campaign currently has 71 specialty society partners and has released
TABLE 1:
SYMPTOMS
POSSIBLE CAUSE
IMAGING
Severe or progressive neurologic deficits – progressive motor weakness, bowel or bladder dysfunction, saddle parasthesias
Cauda equina syndrome
MRI, to consider EMG/NCV
Fever
Vertebral infection
Lumbosacral plain imaging, MRI
Sudden back pain with spinal tenderness
Vertebral compression fracture, cancer (metastases)
Lumbosacral plain imaging, MRI
Trauma
Vertebral compression fracture
Lumbosacral plain imaging
Serious underlying conditions
Cancer, osteoporosis,
steroid use, IVDU, unexplained weight loss
Lumbosacral plain imaging, MRI
Bratton22
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Del Med J | January 2016 | Vol. 88 | No. 1
