Continuous Improvement and the Expansion of Quality ... - NCQA

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T H E S TAT E o f H E A l T H C A R E Q U A l I T y 2 0 1 1 • H E D I S M E A S U R E S o f C A R E results Antibiotic treatment is only infrequently appropriate for acute bronchitis. Misuse or overuse can be avoided by prescribing treatment when necessary, as well as informing patients and clinicians regarding the appropriate use of antibiotics. yEAR trEatMEnt ratE 27 CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 22.5 21.3 NA NA 23.5 2009 24.0 22.6 NA NA 25.6 2008 24.6 26.8 NA NA 25.8 2007 25.4 29.3 NA NA 25.9 2006 28.7 29.7 NA NA 28.0 S A f E T y A N D P o T E N T I A l W A S T E
S A f E T y A N D P o T E N T I A l W A S T E 28 back pain is one of America’s most common medical problems. An estimated 75 percent–85 percent of Americans will experience back pain at some point, 1 and approximately 25 percent of Americans will experience at least one day of back pain during any three-month period. 2 Although imaging is used to diagnose the cause of low back pain, it is costly and ineffective. less than 1 percent of radiographs identify a specific cause of low back pain. 3 The Use of Imaging Studies for Low Back Pain measure assesses the number of patients with lower back pain who did not get an x-ray, MRI or CT scan as part of their treatment. • Although a variety of minor injuries and conditions can lead to back pain, most acute low back pain is benign and selflimiting. Imaging studies are not required for diagnosis. 8 • Studies have shown that patients treated without imaging experience no difference in health outcomes. 4,5 Abnormalities discovered through imaging were as common in individuals without back pain as they were in individuals with low back pain. 4 N AT I o N A l C o M M I T T E E f o R Q U A l I T y A S S U R A N C E USE of IMAGING STUDIES foR loWER bACk PAIN • Imaging for early, acute low back pain can lead to surgery. Complications from unnecessary surgery can prolong back pain or lead to permanent disability. 5 the Case for Improvement • on average, patients with low back pain have higher overall medical costs. Patients with back pain spend an average of $7,211, while comparable patients without back pain spend an average of $2,400 over a two-year period. Patients with low back pain who opt for surgery incur an average of $34,000 in direct medical costs. 8 • According to the Agency for Healthcare Research and Quality (AHRQ), almost 18,000 Americans sought medical attention for low back pain in 2008. Additionally, medical care for these individuals cost approximately $35 billion dollars, with imaging driving much of the cost. 6,7
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ACkNoWlEDGMENTS Health Plans The 20
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Continuous Improvement and the Expansion of Quality ... - NCQA

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