Back Pain Clinical Trial
Official title:
Improving Performance on Choosing Wisely Low Back Pain Measures in Primary Care: Learning From Within
As
Two common low-value services are related to acute low back pain. Choosing Wisely advises avoiding the use of imaging during the first 6 weeks of low back pain (per the American Academy of Family Physicians and other organizations). Similarly, Choosing Wisely advises avoiding opioids in the treatment of low back pain until other alternatives have been attempted (per the North American Spine Society). Together, overutilization of these two services (imaging and opioids for low back pain) costs more than $500 annually, not including downstream costs, and is a source of patient harm. In the state of Virginia, the Virginia Center for Health Innovation has identified the two back pain measures as priority for reducing as part of their 3-year intervention (Smarter Care Virginia): https://www.vahealthinnovation.org/scv/ As a participant in Smarter Care Virginia (SCV), Carilion receives data showing each Carilion Clinic clinician's performance on SCV measures, including the two back pain measures. For example, Carilion receives a database that lists the clinician's name, department, number of appropriate orders for each SCV measure made and the number of low-value orders for each SCV measure made. Carilion (and the other 7 participating health systems) are asked to use this information to generate quality improvement initiatives. We have designed a quality improvement initiative focused on family and community medicine clinicians and the two back pain measures. First, we will use the most recent data provided by the SCV project (2020 and Q1-Q2 of 2021) to rank FCM practices and clinicians by utilization of low-value back pain services, their waste index, and impact score. We will identify from this ranking the top 5 to 10 performing practices and the bottom 5 to 10 performing practices. If there are any outlier clinicians who are bottom performing (ie: provide the most low-value services or have the highest impact score) but who do not fall among the bottom performing practices, we will consider including their practice among the bottom 5 to 10. We will survey clinicians in top and bottom performing practices to learn more about their knowledge, perceptions, and practice workflow related to the two back pain measures. They will also be asked about their trust in data measures. No identifying information will be collected from clinicians in the survey. From what we learn from survey data, we will design up to four brief education points to be communicated during regular practice quality improvement meetings with population health managers. Prior to the delivery of quality improvement education about back pain measures, we will obtain an EMR report for the top and bottom performing practices showing utilization rate of both back pain measures. We will also conduct a chart review (Epic) to identify indication for provision of the back pain services that could not be detected in claims data or Epic data. This addresses a common concern of clinicians - that clinical nuance is not being detected and low value care is being over-assigned. The Epic reports and chart reviews will continue monthly for the first 3 months and then at months 6 and 12. ;
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT05982483 -
Erector Spinae Plane Block vs. Usual Care for ED Patients With Mechanical Back Pain
|
N/A | |
Completed |
NCT04744246 -
Muscle Activity During Load Carriage in ROTC Cadets
|
N/A | |
Completed |
NCT03273114 -
Cognitive Functional Therapy (CFT) Compared With Core Training Exercise and Manual Therapy (CORE-MT) in Patients With Chronic Low Back Pain
|
N/A | |
Active, not recruiting |
NCT03680846 -
Comparison of HF10 Therapy Combined With CMM to CMM Alone in the Treatment of Non-Surgical Refractory Back Pain
|
N/A | |
Completed |
NCT05597189 -
Clinical Study for Palliative/Preventive Treatment of Chronic Back Pain
|
N/A | |
Completed |
NCT05342181 -
Static and Dynamic Core Stability Exercises in Potpartum Back Pain
|
N/A | |
Completed |
NCT02955342 -
Back and Neck Pain in Adolescence
|
||
Completed |
NCT02704845 -
Biopsychosocial Exploration of Pain Profiles in Inflammatory and Chronic Non-specific Axial Low Back Pain
|
N/A | |
Not yet recruiting |
NCT02536274 -
"Examination of the Impact of a Dynamic Flexion Orthosis (Dynaflex®Ottobock) or of a Back Bandage (Lumbo Sensa®Ottobock) on the Voluntary Activation of the Back Muscles in Patients With Specific Back Pain"
|
N/A | |
Recruiting |
NCT02237105 -
The Effect of Cognitive Behavioral Therapy on the Outcome of Spinal Surgery
|
N/A | |
Enrolling by invitation |
NCT02485795 -
Observational Study of the Impact of Genetic Testing on Healthcare Decisions and Care in Interventional Pain Management
|
N/A | |
Completed |
NCT02609009 -
Back Pain and Spinal Manipulation in Adolescent Scoliosis
|
N/A | |
Completed |
NCT02254694 -
The Influence of High Heeled Shoes on the Sagittal Balance of the Spine and Whole Body
|
N/A | |
Terminated |
NCT02239627 -
Epidural Clonidine Versus Corticosteroid for Low Back Pain
|
N/A | |
Completed |
NCT00986180 -
NUCYNTA (Tapentadol Immediate Release) Versus Oxycodone Immediate Release in the Treatment of Acute Low Back Pain
|
Phase 3 | |
Terminated |
NCT00769626 -
Standardizing Management of Patients With Low Back Pain in Primary Care and Physical Therapy
|
Phase 3 | |
Completed |
NCT00771758 -
Tapentadol IR vs Oxycodone IR vs Placebo in Acute Pain From Vertebral Compression Fracture Associated With Osteoporosis
|
Phase 3 | |
Withdrawn |
NCT00231374 -
Measure of Cerebrospinal Fluid (CSF) Pressure Variation With Patient Positioning
|
N/A | |
Completed |
NCT00103675 -
Sensor Measurement of Acupuncture Needle Manipulation
|
Phase 1 | |
Completed |
NCT00454064 -
Cognitive-behavioural Treatment of Chronic Back Pain
|
Phase 3 |