eMeasure Title

Use of Imaging Studies for Low Back Pain

eMeasure Identifier (Measure Authoring Tool) 166 eMeasure Version number 6.0.000
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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Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2015 American Medical Association. LOINC(R) copyright 2004-2015 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2015 International Health Terminology Standards Development Organisation. ICD-10 copyright 2015 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 three quarters of adults at some time in their lives (Chou et al., 2012). 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, 2002). 

Each year in the United States low back pain is experienced by 25 to 50 percent of adults, making it one of the most common reasons for seeking health care services (Haldeman and Dagenais, 2008). Low back pain results in high indirect costs from disability, lost time from work, and decreased productivity while at work, and is the number one cause for activity limitations in younger adults (Chou, 2012). The costs associated with health care services for spine pain (primarily low back pain) in the U.S. increased from $45.9 billion in 1997 to $102.6 billion in 2004 (Martin et al., 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 (2012)

Clinicians should not recommend imaging (including computed tomography [CT], magnetic resonance imaging [MRI] and x-ray) for patients with non-specific low back pain (Strong Recommendation, Moderate Quality Evidence).

* Low back pain assessment should include a subjective pain rating, functional status, patient history including notation of presence or absence of "red flags," psychosocial indicators, assessment of prior treatment and response, employment status, and clinician's objective assessment.
* Reduce or eliminate imaging for diagnosis of non-specific low back pain in patients 18 years and older.
* First-line treatment should emphasize patient education and a core treatment plan, that includes encouraging activity, use of heat, no imaging, cautious and responsible use of opioids, anti-inflammatory and analgesic over-the-counter medications and return to work assessment.
* Patients with acute or subacute low back pain should be advised to stay active and continue ordinary daily activity as tolerated.
* Use opioids cautiously and responsibly in the presence of acute or subacute low back pain.
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. 2007. "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
Chou R, et al. Radiologic Clinics of North America. Appropriate Use of Lumbar Imaging for Evaluation of Low Back Pain. 2012 Jul, Vol. 50, No. 4: 569-85.
Reference
Haldeman S, Dagenais S. A supermarket approach to the evidence informed management of chronic low back pain. Spine J 2008;8: 1-7.
Reference
Institute for Clinical Systems Improvement. 2012. "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
Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008;299: 656-64.
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 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 Population
Patients 18-50 years of age with a diagnosis of low back pain during an outpatient or emergency department visit
Denominator
Equals Initial 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 through the 28 days after 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
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 Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
None