Spine IQ/CECity Low Back Pain QCDR for 2016

Transcription

1 Spine IQ/CECity Low Back Pain QCDR for 2016 Measure #XXX: Repeated X-ray Imaging National Quality Strategy Domain: Patient Safety/Efficiency and Cost Reduction DESCRIPTION: Percent of patients with low back pain who receive two or more of the same x-ray imaging studies within the reporting period INSTRUCTIONS: Measure Reporting via Registry. DENOMINATOR: All visits for patients aged 18 years and older Denominator Criteria (Eligible Cases): Patients aged 18 years on date of encounter AND: Patient encounter during the reporting period (CPT) in which x-ray study is performed spine, single view, specify level thoracolumbar, 2 views spine, lumbosacral, 2 or 3 views spine, lumbosacral, minimum 4 views complete, including bending views pelvis 1 or 2 views SI joints, less than 3 views 72202, SI joints, 3 or more views AND: Diagnosis of LBP (see table 1) NUMERATOR: Patients with two or more of the same x-ray imaging studies within the one year reporting period. Definitions Low Back Pain as defined by the ICD10 codes listed in table 1 G57.00 lesion of sciatic nerve, unspecified lower limb 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

2 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 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

3 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 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

4 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 Exceptions: 1) Patient with a new presenting complaint; 2) patients with documented symptoms that are worsening; 3) patients with documented signs of progressive disease 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 Spine radiography Spine radiography provides clinical information that affects medical decision-making for providers managing spinal pain conditions Routine spine radiography is ordered by some practitioners despite clinical guideline recommendations to the contrary X-ray imaging incurs monetary cost, imparts ionizing radiation, can result in labeling patients with conditions that do not cause pain or represent abnormal pathology, and, in many cases, does not result in improved clinical outcomes. Thus, evidencebased guidelines do not support the routine use of x-ray imaging during the initial evaluation and treatment periods for non-elderly patients with uncomplicated, first-episode, acute or subacute low back pain Conversely, guidelines support the use of x-ray for patients who exhibit red flags, progressive worsening, or a failure to respond to care. Evidence-based recommendations regarding the clinical utility of x-ray imaging are less certain for managing patients with chronic or recurrent episodic low back pain There is no data available that supports the routine use of repeated x-rays when there has not been a change in diagnosis or documented worsening of symptoms or progression of disease.

5 1. 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): C Ammendolia, C Bombardier, S Hogg-Johnson, R Glazier Views on radiography use for patients with acute low back pain among chiropractors in an J Manipulative Physiol Ther, 25 (8) (2002), pp RW Beck, KR Holt, MA Fox, KL Hurtgen-Grace Radiographic anomalies that may alter chiropractic intervention strategies found in a New Zealand population J Manipulative Physiol Ther, 27 (9) (2004), pp AE Bussieres, AM Patey, JJ Francis, et al.identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework Implement Sci, 7 (2012), p Vining RD, Potocki E, McLean I, Seidman M, Morgenthal AP, Boysen J, Goertz C. Prevalence of radiographic findings in individuals with chronic low back pain screened for a randomized controlled trial: secondary analysis and clinical implications.j Manipulative Physiol Ther Nov-Dec;37(9): doi: /j.jmpt Epub 2014 Nov R Chou, A Qaseem, V Snow, et al. 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) (2007), pp AE Bussieres, JA Taylor, C Peterson Diagnostic imaging practice guidelines for musculoskeletal complaints in adults an evidence-based approach part 3: spinal disorders J Manipulative Physiol Ther, 31 (1) (2008), pp R Chou, R Fu, JA Carrino, RA Deyo Imaging strategies for low-back pain: systematic review and metaanalysis Lancet, 373 (9662) (2009), pp JA Taylor, A Bussieres Diagnostic imaging for spinal disorders in the elderly: a narrative review Chiropr Man Ther, 20 (1) (2012), p. 16