Low Back Pain: Use of Imaging Studies (NQF 0052)

eMeasure Name Low Back Pain: Use of Imaging Studies eMeasure Id DD4A4AF0-ADD6-4A75-B94C-AB1D4DDA2583
Version number 1 eMeasure Set Id B141570A-EB00-429A-8394-A7EE2A64AB87
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description The percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
This measure assesses the percentage of patients in a specific age demographic who did not receive an imaging study (i.e., x-ray, MRI, CT scan) in the 28 days following a new episode of low back pain. Low back pain is the second most frequently listed reason for physician office visits. It is a common cause of lost productivity and absenteeism from work in the United States.  The general consensus from literature reviews indicates that nearly half of American adults will experience low back pain in a year, and about two-thirds will suffer from it in their lifetime. Low back pain is particularly prevalent among men and women between 30 and 50 years of age, and most likely results from aging and an inactive lifestyle. Low back pain has a significant financial impact, costing an average of $8,000 per claim (Atlas, Devo 2001). This measure facilitates efforts toward improved musculoskeletal condition and individual quality of life.
Clinical Recommendation Statement
Agency for Healthcare Policy and Research (AHCPR): Plain x-rays are not recommended for routine evaluation of patients with acute low back problems within the first month of symptoms unless a "red flag" [indicator of potentially serious spinal pathology or other nonspinal pathology] is noted on clinical examination. (Strength of evidence: B)  Plain x-rays of the lumbar spine are recommended for ruling out fractures in patients with acute low back problems when any of the following red flags are present: recent significant trauma (any age), recent mild trauma (patient over age 50), history of prolonged steroid use, osteoporosis, patient over age 70. (Strength of evidence: C)  Plain x-rays in combination with CBC and ESR may be useful for ruling out tumor or infection in patients with acute low back problems when any of the following red flags are present: prior cancer or recent infection, fever over 100 degrees F, IV drug abuse, prolonged steroid use, low back pain worse with rest, unexplained weight loss. (Strength of evidence: C). AHCPR recommendations reaffirmed by Jarvik and Deyo, 2002.

American Academy of Orthopaedic Surgeons/ North American Spine Society:   When critical exclusionary diagnoses (eg, cauda equina syndrome, fracture, neoplasm, etc.) NOT suspected, plain lumbar spine x-rays recommended if non-specific lower back pain without radicular symptoms or lower back pain with radicular symptoms remains unresolved after 4-6 weeks of activity modification (e.g., medications, self-applied thermal modalities, etc.). (Evidence not rated)

American College of Radiology:   Uncomplicated low back pain is a benign, self-limited condition that does not warrant any imaging studies. The vast majority of these patients are back to their usual activities in 30 days. The challenge for the clinician, therefore, is to distinguish that small segment within this large patient population that should be evaluated further because of suspicion of a more serious problem.
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002; 137:586-597.
Reference
American Academy of Orthopaedic Surgeons and North American Spine Society. Clinical Guideline on Low Back Pain-Phase 1 (First Contact Physician). 1996.
Reference
Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14 AHCPR Publication No. 95-0642. Rockville MD: AHCPR, Public Health Service, U.S. DHHS. 1994.
Reference
American College of Radiology, ACR Appropriateness Criteria. Acute Low Back Pain-Radiculopathy. www.acr.org.
Definition
Initial Patient Population(s): All patients 18 to 50 years of age during the measurement period
Definition
Denominator(s): Patients in the initial population who had an outpatient or emergency department (ED) encounter with a primary diagnosis of low back pain during the measurement period.
Definition
Denominator Exclusion(s): Patients with a diagnosis of cancer anytime in their history or a diagnosis of recent, trauma, IV drug abuse, or neurologic impairment during the 12 months period prior to the encounter.
Definition
Numerator(s): The number of patient who did not have an imaging study on the date of diagnosis anytime in the following 28 days. 
Note:  this measure is reported as an inverted rate (1-numerator/ eligible population) a higher score indicates appropriate treatment of low back pain.
Definition
Denominator Exception(s): N/A
Guidance
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012