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01:15Methods of Documentation VI: Case Management Model
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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic...
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01:26Methods Of Healthcare Delivery System
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Guideline concordant care for acute low back pain: A mixed-methods analysis of determinants of implementation.
Kate I Minick1, Ashley Krueger2, Amelia Millward1
1Rehabilitation Services, Intermountain Health, Salt Lake City, UT, United States of America.
The American Journal of Emergency Medicine
|December 5, 2024
View abstract on PubMed
Summary
Variation in imaging and physical therapy (PT) use for acute low back pain (LBP) was substantial across emergency departments (EDs) and urgent cares (UCs). Implementation strategies are needed to address clinician barriers and improve guideline adherence for LBP management.
Area of Science:
- Health Services Research
- Implementation Science
- Musculoskeletal Health
Background:
- Acute low back pain (LBP) is a common condition with established guideline recommendations for management.
- Variation exists in the utilization of diagnostic imaging and physical therapy (PT) for acute LBP.
- Understanding determinants of this variation is crucial for optimizing care delivery.
Purpose of the Study:
- To measure variation in imaging and physical therapy (PT) use for acute low back pain (LBP).
- To identify implementation determinants explaining variation in LBP care across emergency departments (EDs) and urgent care (UC) settings.
- To assess concordance with LBP guideline recommendations.
Main Methods:
- An explanatory, sequential mixed-methods study was conducted across 22 EDs and 27 UCs.
Main Results:
- Imaging orders were present in 29% of acute LBP encounters (ED: 43%; UC: 18%); PT orders in 5% (ED: 7%; UC: 4%).
- Clinicians were familiar with LBP guidelines but showed significant variation in knowledge and beliefs regarding their application.
- Identified barriers included varied understanding of PT, complex referral workflows, perceived medico-legal assurance of imaging, and lack of feedback loops.
Conclusions:
- Guideline concordance for imaging and PT in acute LBP varied significantly among ED and UC providers.
- Implementation strategies should target identified barriers to improve adherence to LBP guidelines.
- Future trials should test interventions to reduce imaging overuse and PT underuse for acute LBP.