eMeasure Title Use of Imaging Studies for Low Back Pain
eMeasure Identifier
(Measure Authoring Tool)
166 eMeasure Version number 3
NQF Number 0052 GUID b6016b47-b65d-4be0-866f-1d397886ca89
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Measure Developer National Committee for Quality Assurance
Endorsed By National Quality Forum
Description
Percentage of patients 18-50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.
Copyright
Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). 

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CPT(R) contained in the Measure specifications is copyright 2004-2012 American Medical Association. LOINC(R) copyright 2004-2012 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2012 International Health Terminology Standards Development Organisation. ICD-10 copyright 2012 World Health Organization. All Rights Reserved.
Disclaimer
These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.

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Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Low back pain is a pervasive problem that affects two thirds of adults at some time in their lives. It ranks among the top ten reasons for patient visits to internists and is the most common and expensive reason for work disability in the U.S.  Low back pain is second only to upper respiratory problems as a symptom-related reason for visits to a physician (Jarvik and Deyo 2000; U.S. Preventive Services Task Force 2004). 

Back pain is among the most common musculoskeletal conditions, afflicting approximately 31 million Americans, and is the number one cause of activity limitation in young adults (Rizzo, Abbott, and Berger 1998). Low back pain is responsible for direct health care expenditures of more than $20 billion annually, and as much as $50 billion per year when indirect costs are included (Patel 2000). This accounts for over 4.7 million missed work days per year (Dagenais, Caro, and Haldeman 2008).
Clinical Recommendation Statement
American College of Physicians and the American Pain Society (Chou et al. 2007)
 
Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). 

Institute for Clinical Systems Improvement (2008)

• Back pain assessment should include a subjective pain rating, functional status, patient history including notation of presence or absence of "red flags" (Cauda Equina syndrome or other conditions) and psychosocial indicators, assessment of prior treatment and response, employment status, and clinician's objective assessment.
• Reduce unnecessary imaging unless “red flag” indicators exist.
• A conservative approach should be first-line treatment. Emphasize patient education and conservative home self-care, which includes limited bed rest, early ambulation, postural advice, resumption of light-duty activities, use of ice and heat, anti-inflammatory and analgesic over-the-counter medications, and early return to work or activities.
• Patients with acute low back pain should be advised to stay active and continue ordinary daily activity within the limits permitted by the pain. For chronic back pain, there is evidence that exercise therapy is effective.
• Consult or refer to surgical spine specialist (neurosurgeon, orthopedic surgeon, or other) or non-surgical spine specialist (physical therapist, chiropractic provider, osteopathic or allopathic physician, or other) if conservative treatment fails.

U.S. Preventive Services Task Force (USPSTF) (2004)
The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of interventions to prevent low back pain in adults in primary care settings. (I recommendation)
Improvement Notation
Higher score indicates better quality
Reference
Chou, R., A. Qaseem, V. Snow, D. Casey, J.T. Cross Jr., P. Shekelle, D.K. Owens, and the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel. 2008. “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):478-491.
Reference
Institute for Clinical Systems Improvement. 2008. “Health Care Guideline: Adult Low Back Pain” Bloomington: Institute for Clinical Systems Improvement.
Reference
Jarvik, J.G., and R.A. Deyo. 2002. “Diagnostic evaluation of low back pain with emphasis on imaging.” Ann Intern Med 137:586-597.
Reference
U.S. Preventive Services Task Force. 2004. “Primary care interventions to prevent low back pain in adults.” (February) http://www.uspreventiveservicestaskforce.org/uspstf/uspsback.htm
Reference
Rizzo, J.A. T.A. Abbott, and M.L. Berger. 1998. “The labor productivity effects of chronic backache in the United States.” Med Care 36(10):1471-1488.
Reference
Dagenais, S., J. Caro, and S. Haldeman. 2008. “A systematic review of low back pain cost of illness studied in the United States and internationally.” Spine Journal 8(1):8-20.
Reference
Patel, A.T., and A.A. Ogle. 2000. “Diagnosis and management of acute low back pain.” Am Fam Phys 61(6):1779-1786.  http://www.aafp.org/afp/20000315/1779.html
Definition
This measure applies to the first episode of low back pain during the measurement period.
Guidance
The outpatient or emergency department visit in the Initial Patient Population needs to occur during the first 337 days of the measurement period (337 days allows 28 days for the numerator event). This visit must be the first visit for low back pain during the measurement period.
Transmission Format
TBD
Initial Patient Population
Patients 18-50 years of age with a diagnosis of low back pain during an outpatient or emergency department visit
Denominator
Equals Initial Patient Population
Denominator Exclusions
Exclude patients with a diagnosis of cancer any time in their history or patients with a diagnosis of recent trauma, IV drug abuse, or neurologic impairment during the 12-month period prior to the outpatient or emergency department visit.

Exclude patients with a diagnosis of low back pain within the 180 days prior to the outpatient or emergency department visit.
Numerator
Patients without an imaging study conducted on the date of the outpatient or emergency department visit or in the 28 days following the outpatient or emergency department visit
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
None