Implementing the Keele stratified care model for patients with low back pain: an observational impact study.
The Keele stratified care model for management of low back pain comprises use of the prognostic STarT Back Screening Tool to allocate patients into one of three risk-defined categories leading to associated risk-specific treatment pathways, such that high-risk patients receive enhanced treatment and more sessions than medium- and low-risk patients. The Keele model is associated with economic benefits and is being widely implemented. The objective was to assess the use of the stratified model following its introduction in an acute hospital physiotherapy department setting in Gloucestershire, England.



Physiotherapists recorded data on 201 patients treated using the Keele model in two audits in 2013 and 2014. To assess whether implementation of the stratified model was associated with the anticipated range of treatment sessions, regression analysis of the audit data was used to determine whether high- or medium-risk patients received significantly more treatment sessions than low-risk patients. The analysis controlled for patient characteristics, year, physiotherapists' seniority and physiotherapist. To assess the physiotherapists' views on the usefulness of the stratified model, audit data on this were analysed using framework methods. To assess the potential economic consequences of introducing the stratified care model in Gloucestershire, published economic evaluation findings on back-related National Health Service (NHS) costs, quality-adjusted life years (QALYs) and societal productivity losses were applied to audit data on the proportion of patients by risk classification and estimates of local incidence.



When the Keele model was implemented, patients received significantly more treatment sessions as the risk-rating increased, in line with the anticipated impact of targeted treatment pathways. Physiotherapists were largely positive about using the model. The potential annual impact of rolling out the model across Gloucestershire is a gain in approximately 30 QALYs, a reduction in productivity losses valued at £1.4 million and almost no change to NHS costs.



The Keele model was implemented and risk-specific treatment pathways successfully used for patients presenting with low back pain. Applying published economic evidence to the Gloucestershire locality suggests that substantial health and productivity outcomes would be associated with rollout of the Keele model while being cost-neutral for the NHS.
Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
Adrian
A
Bamford
Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
Andy
A
Nation
Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
Susie
S
Durrell
University of Birmingham, Birmingham, UK.
Lazaros
L
Andronis
Gloucestershire Clinical Commissioning Group, Gloucester, UK.
Ellen
E
Rule
University of Birmingham, Birmingham, UK. h.s.t.mcleod@bham.ac.uk.
Hugh
0000-0002-2266-7303
H
McLeod
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D059825:Physical Therapists / Q000523:psychology / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000191:economics; D018570:Risk Assessment; D055815:Young Adult
Economic evaluation; IMPaCT Back; Implementation study; Low back pain; Physiotherapy; STarT Back Screening Tool; Stratified care model