Spine IQ/CECity Low Back Pain QCDR for 2016

Transcription

1 Spine IQ/CECity Low Back Pain QCDR for 2016 Measure #XXX: Change in Pain Intensity National Quality Strategy Domain: Effective Clinical Care DESCRIPTION: Average percent change in pain intensity between the first date of a care encounter and each subsequent encounter closest to a 14 day interval during the reporting period for patients aged 18 years and older with a diagnosis of low back pain. INSTRUCTIONS: This measure is to be reported at each visit in which a PROMIS Pain Intensity Numerical Rating Scale (NRS) instrument is completed during the 12 month reporting period. DENOMINATOR: Denominator Criteria (Eligible Cases): Patients aged 18 years on date of encounter AND : Patient encounter during the reporting period (CPT): , , ; AND: Diagnosis of LBP (See Table 1) AND: A baseline pain intensity assessment using PROMIS Pain Intensity NRS AND: At least one follow up pain intensity assessment using PROMIS Pain Intensity NRS is completed and a value is recorded during the reporting period NUMERATOR: The sum of (baseline pain intensity follow-up pain intensity)/baseline pain intensity for all patients who meet the denominator criteria across all follow up visits in which a pain intensity instrument is completed and a value recorded. Definitions: PROMIS Pain Intensity NRS How would you rate your pain on average? [scale] 0 = No Pain 10 = Worst Imaginable Pain Baseline Assessment: The initial date of a care encounter within the reporting period in which a PROMIS pain intensity NRS is completed and a value is recorded Follow-up assessment: PROMIS Pain Intensity NRS is completed and a value is recorded at 14 day intervals (operationalized as the closest visit to the 14 day mark, either before or after) during a patient care encounter subsequent to the baseline assessment Low Back Pain as defined by the ICD10 codes listed in the table below G57.00 lesion of sciatic nerve, unspecified lower limb

2 G57.01 lesion of sciatic nerve, right lower limb G lesion of sciatic nerve, left lower limb M40.05 hyperlordosis, thoracolumbar region M40.15 kyphosis, thoracolumbar region M unspecified kyphosis, thoracolumbar region M unspecified kyphosis, site unspecified M other kyphosis, thoracolumbar region M other kyphosis, site unspecified M40.36 hypolordosis, lumbar region M40.37 hypolordosis, lumbosacral region M40.35 hypolordosis, thoracolumbar region M40.30 hypolordosis, site unspecified M40.50 lordosis unspecified, site unspecified M40.55 lordosis unspecified, thoracolumbar region M40.56 lordosis unspecified, lumbar region M40.57 lordosis unspecified, lumbosacral reg M41.05 scoliosis, thoracolumbar M41.06 scoliosis, lumbar M41.07 scoliosis, lumbosacral M41.08 scoliosis, sacral and sacrococcygeal M41.25 other idiopathic scoliosis, thoracolumbar M41.26 other idiopathic scoliosis, lumbar M41.27 other idiopathic scoliosis, lumbosacral M41.45 neuromuscular scoliosis, thoracolumbar M41.46 neuromuscular scoliosis, lumbar M41.47 neuromuscular scoliosis, lumbosacral M41.85 scoliosis (other), thoracolumbar region M41.86 scoliosis (other), lumbar region M41.87 scoliosis (other), lumbosacral region M41.9 scoliosis (other), unspecified M43.05 spondylolysis, thoracolumbar region M43.06 spondylolysis, lumbar region M43.07 spondylolysis, lumbosacral region M43.08 spondylolysis, sacral and sacrococcygeal region M43.09 spondylolysis, multiple sites in spine M43.15 spondylolisthesis, thoracolumbar region M43.16 spondylolisthesis, lumbar region M43.17 spondylolisthesis, lumbosacral region M43.18 spondylolisthesis, sacral and sacrococcygeal region M43.19 spondylolisthesis, multiple sites in spine M43.25 fusion of spine, thoracolumbar region

3 M43.26 fusion of spine, lumbar region M43.27 fusion of spine, lumbosacral region M43.28 fusion of spine, sacral and sacrococcygeal region M43.8X5 other unspecified dorsopathies, thoracolumbar region M43.8X6 other unspecified dorsopathies, lumbar region M43.8X7 other unspecified dorsopathies, lumbosacral region M43.8X8 other unspecified dorsopathies, sacral and sacrococcygeal region M43.8X9 other unspecified dorsopathies, site unspecified M43.9 other unspecified dorsopathies M47.15 spondylosis w myelopathy, thoracolumbar region M47.16 spondylosis w myelopathy, lumbar region M spondylosis w/out myelopathy or radiculopathy, lumbar region M spondylosis w/out myelopathy or radiculopathy, lumbosacral region M other spondylosis, lumbar region M other spondylosis, lumbosacral region M48.05 spinal stenosis, thoracolumbar region M48.06 spinal stenosis, lumbar region M48.07 spinal stenosis, lumbosacral region M48.08 spinal stenosis, sacral and sacrococcygeal region M48.15 ankylosing hyperostosis, thoracolumbar region M48.16 ankylosing hyperostosis, lumbar region M48.17 ankylosing hyperostosis, lumbosacral region M48.18 ankylosing hyperostosis, sacral and sacrococcygeal region M48.25 kissing spine, thoracolumbar region M48.26 kissing spine, lumbar region M48.27 kissing spine, lumbosacral region M51.26 other intervertebral disc displacement, lumbar region M51.27 other intervertebral disc displacement, lumbosacral region M51.36 other intervertebral disc degeneration, lumbar region M51.37 other intervertebral disc degeneration, lumbosacral region M53.2x7 spinal instabilities, lumbosacral region M53.2x8 spinal instabilities, sacral & sacrococcygeal region M53.3 sacrococcygeal disorder nec M53.80 other specified dorsopathies, site unspecified M53.86 other specified dorsopathies, lumbar region M54.00 panniculitis affecting regions of neck and back, site unspecified M54.16 radiculopathy, lumbar region M54.17 radiculopathy, lumbosacral region

4 M54.30 sciatica, unspecified side M54.31 sciatica, right side M54.32 sciatica, left side M54.30 sciatica, unspecified side M79.1 myofascial pain M99.03 segmental & somatic dysfunction, lumbar region M99.04 segmental & somatic dysfunction, sacrum Q congenital kyphosis, thoracolumbar Q congenital lordosis, lumbar Q76.49 other congenital malformations spine, not assoc with scoliosis S33.5xx_ sprain of ligaments of lumbar spine S33.6xx_ sprain of sacroiliac joint S33.8xx_ sprain of other parts of lumbar spine and pelvis S39.011_ strain of muscle, fascia, and tendons of abdomen S39.012_ strain of muscle, fascia, and tendons of lower back S39.013_ strain of muscle, fascia, and tendon of pelvis RATIONALE: Public Health Significance of Managing Low Back Pain Low back pain (LBP) is one of the most common reasons for which adults seek health care in the US. 1-3 The prevalence of LBP among adults has been estimated at 15-20%, with 50-80% of people having a significant episode of back pain at some point in their life, 4 and 23% of LBP patients reporting pain of high intensity with disability. 5 Approximately 60% of patients with acute LBP recover by 6 weeks and 80-90% do so by 12 weeks. However, the cumulative risk of suffering a recurrent episode within 12 months is 73%. 6 LBP is also an extremely costly condition. 7-9 From 1997 to 2005, the cost of caring for US adults with spine problems increased by 65% even as the outcomes of care failed to improve. 8 In 2004, the estimated annual direct cost of treating back pain in the US was $193.9 billion. 10 In addition, annual indirect costs for lost wages resulting from back pain add substantially to this cost: in 2004, 25.9 million persons lost an average of 7.2 days of work due to back pain, a total of million workdays lost that year. 5;10 The burden of disease associated with LBP is largely attributed to the fact that, in many instances, acute episodes become chronic conditions. 5 About one fifth of chronic pain patients are not satisfied by the care they receive and more than 70% feel that prescription medication does not effectively manage their pain. 11 Inadequately managed chronic pain results in greater loss of productivity, increased expenditures on more invasive treatment procedures, additional out-of-pocket patient expenses, and increased expenditures for hospitalization, surgery and medications. 11 Chiropractic Manipulative Treatment for Adults with LBP Patients with LBP often seek relief with complementary and alternative medicine, particularly mind and body therapies such as CMT. 12 Randomized controlled trials have demonstrated that spinal manipulation is an effective, conservative treatment option for certain types of LBP, and a metaanalysis indicates that combined chiropractic interventions improved pain and disability in the short term and pain in the medium term for acute and sub-acute LBP. 16 A study of older Medicare beneficiaries with uncomplicated back pain found that CMT has protective effects against declines in ADLs, instrumental ADLs, and self-rated health.over a 2-year period. 16 Several organizations have

5 endorsed the use of spinal manipulation for chronic low back pain treatment: the American Pain Society/American College of Physicians Clinical Practice guidelines supports spinal manipulation for treatment of chronic or subacute LBP 17 the American Geriatric Society has found CMT appropriate for managing chronic back pain in older adults, 18 and the Joint Commission recently added chiropractic therapy to its pain management standards. 19 CMT is popular, currently used by approximately as many as 14% of US adults annually, 20 covered by the majority of health care payer systems, including Medicare and Medicaid, and generated more than $5.9 billion in payments in While there is good evidence of a modest effect of spinal manipulation on LBP in the context of clinical trials, little is known about CMT outcomes in real world clinical settings. Participant-rated pain intensity This pain intensity measure was developed to serve as the outcome measure associated with the 2015 PQRS Measure #131: Pain Assessment and follow-up, a process measure. 22 The Numerical Rating Scale (NRS) has excellent metric properties, is easy to administer and score, and is used often in LBP research. 23 It has been demonstrated to be valid, reliable, and sensitive to detecting change in pain intensity after treatment. 23 NRS measures have advantages over visual analogue scale (VAS) measures, including ability to be administered by telephone, preference by patients, and less missing and incomplete data. 24 The Patient Reported Outcomes Measurement Information System (PROMIS) NRS anchors (0 = No Pain 10 = Worst Imaginable Pain) were chosen because PROMIS is an NIH-sponsored initiative whose goal is to create a system of highly reliable, precise measures of patient reported health status for physical, mental, and social well being Andersson GB. Epidemiological features of chronic low-back pain. Lancet 1999 Aug 14;354(9178): Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976) 1995 Jan 1;20(1): Manek NJ, Macgregor AJ. Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol 2005 Mar;17(2): Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin 2007 May;25(2): Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 2009 Jul;12(4):E35-E70 6. Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ 2003 Aug 9;327(7410):323. PMCID:PMC Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008 Jan;8(1): Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD. Expenditures and health status among adults with back and neck problems. JAMA 2008 Feb 13;299(6): Weiner DK, Kim YS, Bonino P, Wang T. Low back pain in older adults: are we utilizing healthcare resources wisely? Pain Med 2006 Mar;7(2): AAOS. The Burden of Muscuoloskeletal Diseases in the United States. Rosemont, IL: AAOS; Gupta A, Mehdi A, Duwell M, Sinha A. Evidence-based review of the pharmacoeconomics related to the management of chronic nonmalignant pain. J Pain Palliat Care Pharmacother 2010 Jun;24(2): Sherman KJ, Cherkin DC, Connelly MT, Erro J, Savetsky JB, Davis RB, Eisenberg DM. Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try? BMC Complement Altern Med 2004 Jul 19;4:9. PMCID:PMC503394

6 13. Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJ, Bouter LM. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2004;(3):CD Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Bronfort G, Hoving JL. Manipulation or mobilisation for neck pain. Cochrane Database Syst Rev 2010;(1):CD Rubinstein SM, van MM, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev 2011;(2):CD Jensen MP, Karoly P. Self-report Scales and Procedures for Assessing Pain in Adults. In Handbook of Pain Assessment. Guilford Press; p Chou R, Qaseem A, Snow V, Casey D, Cross JT, Jr., Shekelle P, Owens DK. 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 2007 Oct 2;147(7): The management of chronic pain in older persons: AGS Panel on Chronic Pain in Older Persons. J Am Geriatr Soc 1998 May;46(5): The Joint Commission. Revisions to pain management standard effective January 1, [cited 2014 November 12]. Available from: zkaljf6n8ep%2bdpuq%3d&j= &e=mhandel@chpnet.org&l=9552_html&u= &mid= &jb=0 -.VGPfTmczHn0.facebook 20. Weeks WB, Goertz CM, Meeker WC, Marchiori DM. Public Perceptions of Doctors of Chiropractic: Results of a National Survey and Examination of Variation According to Respondents Likelihood to Use Chiropractic, Experience with Chiropractic, and Chiropractic Supply in Local Health Care Markets. J Manipulative Physiol Ther 2015;38(8): Davis MA, Sirovich BE, Weeks WB. Utilization and expenditures on chiropractic care in the United States from 1997 to Health Serv Res 2010 Jun;45(3): PMCID:PMC PQRS Measure #131: Pain Assessment and Follow-Up. Available from: Farrar JT, Young JP, Jr., LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001 Nov;94(2): Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976) 2005 Jun 1;30(11):