Percentage of patients 18-50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.

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Low back pain is a pervasive problem that affects three quarters of adults at some time in their lives (Chou, 2012). It ranks among the top ten reasons for patient visits to internists and is the most common and expensive reason for work disability in the U.S.  Low back pain is second only to upper respiratory problems as a symptom-related reason for visits to a physician (Jarvik and Deyo 2002; U.S. Preventive Services Task Force 2004). 

Each year in the United States low back pain is experienced by 25 to 50 percent of adults, making it one of the most common reasons for seeking health care services (Haldeman, 2008). Low back pain results in high indirect costs from disability, lost time from work, and decreased productivity while at work, and is the number one cause for activity limitations in younger adults (Chou, 2012). The costs associated with health care services for spine pain (primarily low back pain) in the U.S. increased from $45.9 billion in 1997 to $102.6 billion in 2004 (Martin, 2008).

American College of Physicians and the American Pain Society (Chou et al. 2007)
 
Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). 

Institute for Clinical Systems Improvement (2012)

Clinicians should not recommend imaging (including computed tomography [CT], magnetic resonance imaging [MRI] and x-ray) for patients with non-specific low back pain (Strong Recommendation, Moderate Quality Evidence).

•Low back pain assessment should include a subjective pain rating, functional status, patient history including notation of presence or absence of "red flags," psychosocial indicators, assessment of prior treatment and response, employment status, and clinician's objective assessment.
 •Reduce or eliminate imaging for diagnosis of non-specific low back pain in patients 18 years and older.
 •First-line treatment should emphasize patient education and a core treatment plan, that includes encouraging activity, use of heat, no imaging, cautious and responsible use of opioids, anti-inflammatory and analgesic over-the-counter medications and return to work assessment.
 •Patients with acute or subacute low back pain should be advised to stay active and continue ordinary daily activity as tolerated.
 •Use opioids cautiously and responsibly in the presence of acute or subacute low back pain. 

U.S. Preventive Services Task Force (USPSTF) (2004)
The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of interventions to prevent low back pain in adults in primary care settings. (I recommendation)

Higher score indicates better quality

Chou, R., A. Qaseem, V. Snow, D. Casey, J.T. Cross Jr., P. Shekelle, D.K. Owens, and the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel. 2007. “Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society.” Ann Intern Med 147(7):478-491.

Chou R, et al. Radiologic Clinics of North America. Appropriate Use of Lumbar Imaging for Evaluation of Low Back Pain. 2012 Jul, Vol. 50, No. 4: 569-85.

Haldeman S, Dagenais S. A supermarket approach to the evidence informed management of chronic low back pain. Spine J 2008;8: 1–7.

Institute for Clinical Systems Improvement. 2012. “Health Care Guideline: Adult Low Back Pain” Bloomington: Institute for Clinical Systems Improvement.

Jarvik, J.G., and R.A. Deyo. 2002. “Diagnostic evaluation of low back pain with emphasis on imaging.” Ann Intern Med 137:586-597.

Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008;299: 656–64.

U.S. Preventive Services Task Force. 2004. “Primary care interventions to prevent low back pain in adults.” (February) http://www.uspreventiveservicestaskforce.org/uspstf/uspsback.htm

This measure applies to the first episode of low back pain during the measurement period.

The outpatient or emergency department visit in the Initial Patient Population needs to occur during the first 337 days of the measurement period (337 days allows 28 days for the numerator event). This visit must be the first visit for low back pain during the measurement period.

TBD

Patients 18-50 years of age with a diagnosis of low back pain during an outpatient or emergency department visit

Equals Initial Patient Population

Exclude patients with a diagnosis of cancer any time in their history or patients with a diagnosis of recent trauma, IV drug abuse, or neurologic impairment during the 12-month period prior to the outpatient or emergency department visit.

Exclude patients with a diagnosis of low back pain within the 180 days prior to the outpatient or emergency department visit.

Patients without an imaging study conducted on the date of the outpatient or emergency department visit or in the 28 days following the outpatient or emergency department visit

Not Applicable

None

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.