This article series is a monthly tool to help physicians maximize patient health outcomes in accordance with NCQA?s¹ HEDIS^®2 measurements for high quality care on important dimensions of services.

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HEDIS^® definition

Use of imaging studies for low back pain: The percentage of commercial members with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.

Note: This measure is reported as an inverted rate (1 ? [numerator/eligible population]). A higher score indicates appropriate treatment of low back pain (i.e., the proportion for whom imaging studies did not occur).

The importance of imaging studies for low back pain

Low back pain is a pervasive problem that affects two-thirds of adults at some time in their lives. It ranks among the top ten reasons for patient visits to internists and is the most common and expensive reason for work disability in the U.S. For most individuals, back pain quickly improves. Nevertheless, approximately 15 percent of the U.S. population reports having frequent low back pain that lasted for at least two weeks during the previous year. Persistent pain that lasts beyond 3 to 6 months occurs in only 5 percent to 10 percent of patients with low back pain. According to the American College of Radiology, uncomplicated low back pain is a benign, self-limited condition that does not warrant imaging studies. The majority of patients are back to their usual activities in 30 days.

— NCQA, HEDIS 2013 V1

Plan performance

With a total population of about 12,000 members, if just 177 additional members were appropriately treated for low back pain, the commercial rate would exceed the HEDIS^® 75th percentile.

¹ The National Committee for Quality Assurance (NCQA) is the most widely recognized accreditation program in the U.S.

² The Healthcare Effectiveness Data and Information Set (HEDIS) is an NCQA tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.