1. Spine/Low Back Pain Topic Update January 31, 2013 1

2. Two Tracks 1. Spine SCOAP In October 2012, Bree Collaborative unaminously approved Spine SCOAP proposal: “Establish participation in Spine SCOAP as a community standard, starting with hospitals performing spine surgery” Next Step – send recommendation to HCA 2. Spine/Low Back Pain Workgroup Established to identify and recommend strategies for appropriate identification and management of acute low back pain 2

3. Spine/Low Back Pain Workgroup Update

4. Overview Have met twice since the last Bree Collaborative meeting (3 meetings total) RECAP – Focus on preventing transition from acute to chronic pain, as requested by the Bree Collaborative More specifically, focus on identifying high-cost patients as early as possible with comprehensive assessment that includes psychosocial screening At last meeting, agreed on a general outline for the report – based on the organization of the Bree Collaborative’s Obstetrics report 4

5. General Approach 1. Recommend adoption of evidence-based guidelines 2. Identify modalities that are over-used in treatment of low back pain in WA 3. Identify best practices that would lead to appropriate/reduced use of those modalities, which will include some patient and provider education strategies Recognize that it is important to avoid a “one size fits all” approach and try to highlight diverse initiatives that can be implemented in a broad range of settings 5

6. Proposals Currently Under Consideration Support the widespread adoption of ACP/APS guidelines in primary care settings in WA ACP/APS guidelines recommended by Oregon’s Evidence-based Clinical Guidelines Project in 2011 Only guidelines related to Lumbar MRI that the Advanced Imaging Management Group rated as good in all 3 categories in its 2009 report Use the possible causes and key features from the ACP/APS guidelines to define “red flags” Guidelines include a summary table 6

7. Staff Goals in Advance of February Meeting Compile material about promising initiatives including decision support tools Identify areas of over-use and try to find data to serve as a baseline measure May also want to find data about use of best practices (such as physiatrist visits) so we have baseline measures for things that we would like to see used more Any recommended data sources? 7

8. Initiatives Currently Under Review Virginia Mason Back Pain Collaborative Intel Program in Oregon (modeled after VMMC) STarT Back Tool University of Washington System COHE Program Spine SCOAP & Spine Tango Project ECHO Imaging Controls at VMMC & Everett Clinic Programs at Kaiser and University of Michigan Any others that we should consider? 8

9. Questions? Comments? 9