title: Bridging the gap between science and practice in managing low back pain. A comprehensive spine care system in a health maintenance organization setting.
abstract: METHODS
  A case study of spine care system changes in a multispecialty group practice health maintenance organization setting.
  
  
  OBJECTIVE
  To reduce unnecessary use of imaging and specialty referrals for low back pain in the primary care setting and to reduce spine surgery rates.
  
  
  BACKGROUND
  Results of previous research indicate that diagnostic and therapeutic procedures for low back pain are frequently used even though there is no scientific evidence of their efficacy. This indicates that low back pain care can be made more efficient by reducing the use of unproven diagnostic and therapeutic interventions for low back pain.
  
  
  METHODS
  Rates of diagnostic imaging and specialty referral rates for low back pain were monitored for 9 months before and 9 months after primary care physician education regarding appropriate low back pain evaluation and management. Spine surgery rates were also monitored before and after implementation of a nonsurgical spine clinic.
  
  
  RESULTS
  Large reductions in rates of imaging and specialty referrals for low back pain were achieved after primary care physician education. After spine clinic implementation, visits to spine surgeons dropped by approximately 50%, and spine surgery rates per thousand health plan members were reduced by 35%.
  
  
  CONCLUSIONS
  Primary care physician education regarding low back pain management can reduce use of imaging and specialty referrals without reductions in patient satisfaction, and implementation of a nonsurgical spine clinic for complex or chronic spine patients can significantly reduce spine surgery consultations and spine surgery rates.
authors.affiliation: Lovelace Health Systems, Albuquerque, New Mexico, USA. Ben.Klein@LOVELACE.com
authors.forename: B J
authors.initials: BJ
authors.lastname: Klein
authors.forename: R T
authors.initials: RT
authors.lastname: Radecki
authors.forename: M P
authors.initials: MP
authors.lastname: Foris
authors.forename: E I
authors.initials: EI
authors.lastname: Feil
authors.forename: M E
authors.initials: ME
authors.lastname: Hickey
mesh_terms: D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational; D006123:Group Practice; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D019982:Organizational Case Studies; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*