Low back pain: development and five-year prospective application of a computerized quality-based diagnostic and treatment protocol.
A standardized protocol for low back pain was developed and computerized so that it could be used as a concurrent monitoring system for large patient populations. The software incorporated a relational database management system (RDBMS) and C language, a flexible, general-purpose programming language that is fast and portable. The protocol was then applied to a uniform group of industrial patients for 5 years. The results demonstrated that a quality-based protocol could be successfully computerized and applied to a large group of patients as a concurrent monitoring system. Quality care was insured by adherence to the computerized protocol. Associated economic results showed decreases in actual number of accidents each year (from 98/year prior to the study to 42/year in the last study year), in lost work days (from 3640/year before the study to 2118/year in the last year), and in costs (savings averaged $430,000/year). The goal of this study was to provide quality medicine; the economic benefits were a bonus. The monitoring system differed from those of the past in that it was driven by the basic medical information taken from the history, physical examination, and radiograph findings. The monitoring physicians were unbiased because they were not allowed to become involved in the patient's ongoing care. There was no rebound phenomenon (an initial drop in cases followed by a gradual return to the prestudy level); this was attributed to the constant monitoring of each case from beginning to end. These results led to the following conclusions: (a) Computerization of a standardized medical approach for low back pain is practical.(ABSTRACT TRUNCATED AT 250 WORDS)
Wiesel
S W
SW
Department of Orthopaedic Surgery, George Washington University, Washington, D.C. 20037.
Feffer
H L
HL
Rothman
R H
RH
D001416:Back Pain / Q000175:diagnosis* / Q000628:therapy; D003936:Diagnosis, Computer-Assisted; D017048:Health Care Costs; D006801:Humans; D008161:Lumbosacral Region; D011446:Prospective Studies; D011787:Quality of Health Care; D013813:Therapy, Computer-Assisted / Q000191:economics