Outcomes measures for patients with back pain in Minnesota could change, and the North American Spine Society hopes a recent letter to the measure development team could influence broad implementation.
As part of the public comment period for the "Acute and Sub-Acute Low Back Pain Functional Status Outcome Measure" developed by the Minnesota Community Measurement and Chiropractic Care of Minnesota Measure Development Team, NASS sent a letter agreeing with the overall concept, but highlighting issues to address before the measures are implemented.
Key issues addressed in the letter include:
1. Using electronic medical record data to indicate whether patients had same-specialty encounters 180 days before treatment — this method could be unreliable, NASS argues, and recommends using additional mechanisms including self-reporting as well.
2. Making the time period cut-off 12 weeks — this broad time period would measure patients at four weeks in the same category as those reporting at 12 weeks and there could be huge differences in treatment outcomes at four weeks versus 12. NASS recommends a more specific and constant interval.
3. Cost value — there isn't a metric for evaluating cost currently in the measure, although lower cost was a factor driving measure development.
4. The measure doesn't include room to document whether patients experience new or recurrent symptoms.
5. Recommendations for the measures to include mental health status — many back pain patients have depression, anxiety or fear-avoidance. Other co-morbidities such as smoking and BMI should be recorded and considered, NASS recommends.
There were also coding considerations highlighted in the letter.