Adaptation and Implementation of the STarT Back Risk Stratification Strategy in a US Health Care Organization: A...

Area of Science:

• Health Services Research
• Implementation Science
• Musculoskeletal Health

Background:

• Effective back pain management requires accessible, stratified care models.
• The STarT Back (STool for THe Reporting of TReatment) Back risk-stratified care model has shown promise internationally.
• Adapting and implementing evidence-based interventions in new healthcare settings presents unique challenges.

Purpose of the Study:

• To evaluate the implementation process of an adapted STarT Back risk-stratified care model in a US healthcare system.
• To identify key learnings and facilitators for adopting complex practice change interventions in primary care.

Main Methods:

• A logic model-driven process evaluation using qualitative data sources.
• Data collection included observations, staff/provider interviews, and post-training questionnaires.
• Thematic analysis of qualitative data and descriptive statistics were employed for analysis.

Main Results:

• Training for the STarT Back approach received high scores for engagement and usefulness from primary care teams and physical therapists.
• Significant variation existed in the integration of the risk-stratification strategy into routine care.
• While confidence in managing back pain increased for some providers, referral rates for matched treatments did not change.

Conclusions:

• The implementation of the STarT Back model in the US highlighted the need for simplified primary care interventions.
• Ongoing monitoring and feedback mechanisms are crucial for successful adoption of complex practice change strategies.
• Learnings from this evaluation can inform future adaptations and implementations of the STarT Back strategy and similar interventions.