Implementation of a Quality Improvement Process Aimed to Deliver Higher-Value Physical Therapy for Patients With Low Back Pain: Case Report

Emily Karlen; Becky McCathie

doi:10.2522/ptj.20150035

Figures

Figure 1.

Patients with low back pain (LBP) entering outpatient physical therapy from 2010 through 2014. ODI=Oswestry Disability Index, KSBT=Keele STarT Back Tool.

Figure 2.

Operational structure of low back pain programming depicting accountabilities (solid line) and collaborations (dotted line).

Figure 3.

Graphs demonstrating increased value in the physical therapy (PT) delivered. Data included for patients who completed a first visit Oswestry Disability Index (ODI) and a last visit ODI (n=17,078). (A) Change in disability, as measured with the ODI, and mean number of PT visits by year. (B) Mean percentage of change in ODI score per PT visit by year.

Appendix 1.

ICD-9 Diagnosis Codes Used to Define Population With Low Back Pain

Appendix 3.

Treatment Codes Used to Define Guideline-Adherent Physical Therapy for Low Back Pain

Tables

Table 1.

Strategic Time Line^{^a}

↵^a Q1=first quarter, Q2=second quarter, Q3=third quarter, Q4=fourth quarter, ODI=Oswestry Disability Index, LBP=low back pain, QIT=quality improvement team, KSBT=Keele STarT Back Tool.

Table 2.

Yearly Patient-Reported Outcomes and Utilization Data^{^a}

↵^a Includes all patients entering physical therapy for management of low back pain (LBP) (N=47,755). ODI=Oswestry Disability Index, KSBT=Keele STarT Back Tool, N/A=not applicable.
^b Baseline data collection year.
^c Percent ODI improvement calculation=(first ODI – last ODI)/first ODI × 100.

Table 3.

Number of Patients Entering Physical Therapy for Management of Low Back Pain^{^a}

↵^a Patients were subclassified according to whether they received guideline-adherent care, defined as having more than 75% of all charges, and more than one visit, as defined by Fritz et al.²⁶ Current Procedural Terminology (CPT) codes are listed in Appendix 3.