Atlantic Health System - Morristown Medical Center Family Medicine Residency - Morristown, NJ Florham Park, New Jersey
Background and Hypothesis:
Background: Lower back pain is one of the most costly and common musculoskeletal complaints for a primary care provider to address. It can be very difficult to diagnose and treat as treatment approaches can vary widely and there are a wide range of modalities that may be incorporated to identify the source. Both treatment and diagnostic modalities can unnecessarily increase healthcare costs for both the patient and the healthcare system.
This quality improvement project aims to determine if a lecture series that provides a comprehensive review of the different causes of low back pain and provides a stepwise approach to treating it can reduce the number of unnecessary referrals, imaging, and medications ordered.
Hypothesis: This QI project hypothesizes that after healthcare providers have viewed the instructional lecture, the amount of imaging ordered, referrals generated, and medications prescribed will be more consistent with standards of care, thus increasing the quality and efficiency of care, while reducing unnecessary healthcare costs.
Methods:
Methods: All of the office patients seen for acute back pain at the Morristown Family Medicine office from January 2023 through September 2023 will have their charts reviewed. Inclusion criteria include any patient presenting to the office with a chief complaint of acute lower back pain (Onset within 4 weeks of presentation).
Exclusion criteria include subacute/chronic back pain (greater than 4 weeks duration and greater than 12 weeks, respectively), and patients solely being seen for Osteopathic Manipulative Treatment.
Criteria for comparison will be broken up into the following categories: Suspected diagnosis, imaging ordered, referrals generated, and medications prescribed.
The sample size includes 120 cases in the pre-intervention group. The post lecture group patient information is currently being collected and will be finalized at the end of February 2024.
In the meantime, a videotaped lecture was shown to all the office providers. The lecture focused on lower back pain, causes, appropriate imaging, medications, and referrals. From October 2023 until February 2024, all office visits for lower back pain will be tracked, and the same categories will be assessed at the end of the data collection period: Suspected diagnosis, imaging ordered, referrals generated, and medications prescribed. This data set will then be compared to the first to determine how these categories have changed.
Additionally, clinic providers will be given a pre and post interventional knowledge assessment in order to gauge effectiveness of the instructional video in familiarizing them with the evidence-based approach to acute lower back pain.
Results:
Results: Results are pending as post interventional data needs to be collected.
Conclusion:
Conclusions: Pending post interventional data.
Acknowledgement of Research Study Sponsors and IRB: Mentors for the study: Dr. Bernadette Bibber, DO Dr. Jonathan W. Torres, DO
This study was reviewed and approved by the institution of Atlantic Health/Morristown Medical Center and was determined to be IRB exempt. Research was conducted at my residency, Morristown Medical Center Family Medicine. Exemption letter will be attached to the application.
