Assess & Improve the Quality of Care For Low Back Pain

正如本提案的主题所反映的那样，申请人有两个主要的职业目标：（1）评估下腰痛手术和非手术治疗的质量;（2）。减少治疗实践中的差异并改善这些疾病的治疗结果。这个为期五年的项目结合了成果研究和持续质量改进技术的使用，以缩小通过成果研究获得的知识与临床实践之间的差距，以改善腰痛患者的结局。尽管它的频率和相关的成本，很少有人知道的护理脊柱疾病的质量。最近启动的脊柱患者结局研究试验（SPORT）提供的数据和基础设施为研究、比较和改善接受三种可手术治疗的脊柱疾病治疗的患者的结局提供了独特的机会：椎间盘突出、椎管狭窄和退行性脊椎前移。SPORT是一组临床试验，旨在比较手术和非手术方法治疗这些疾病的有效性，目前正在美国II医疗中心进行，预计将招募约3000名患者。该提案的总体目标是通过对参与SPORT的医疗中心的护理结构、过程和结果进行比较研究，评估和提高腰痛护理质量。具体而言，本研究有三个研究目标：1. 表征临床实践。我们计划详细研究 低血糖患者的护理结构和过程的可变性 背部疼痛的网站参与运动。2. 评估护理结果。在开发和验证风险调整方法后，我们将评估和比较参与SPORT的II研究中心的腰痛护理质量。在手术和非手术治疗的患者中评估的结局将包括功能健康状况、临床结局、患者满意度和成本。3. 将临床实践和结果联系起来。使用统计模型来解释分层数据结构设置中的随机变化，我们将检查临床结构，过程和结果之间的关联，以确定需要改进的高杠杆区域。改善临床护理不能发生在真空中， 研究实验室。在该项目的每一步，我们都将 将数据反馈给参与医疗的临床医生， 中心，并与他们合作，制定一个集中的质量改进议程，旨在通过减少临床实践中的变异性来改善患者的结果。

As reflected in the-topic of this proposal, the applicant has two main career goals: (I) to evaluate the quality of surgical and non-surgical treatment for low back pain; and (2). to reduce variation in treatment practices and improve the outcomes of treatment for these conditions. This five-year project combines the use of outcomes research and continuous quality improvement techniques to close the gap between knowledge gained through outcomes research and clinical practices to improve outcomes for patients with low back pain. Despite its frequency and related costs, little is known about the quality of care for spinal disorders. The data and infrastructure provided by the recently initiated Spine Patient Outcomes Research Trials (SPORT) presents a unique opportunity to study, compare, and improve outcomes for patients undergoing treatment for three surgically treatable spine conditions: herniated disc, spinal stenosis, and degenerative spondylolisthesis. SPORT is a set of clinical trials to compare the effectiveness of surgical and non-surgical approaches to the treatment of these conditions that is being conducted at II U.S. medical centers and expects to enroll approximately 3000 patients. The overall goals of this proposal are to evaluate and improve the quality of care for low back pain through a comparative study of the structure, process, and outcomes of care at medical centers participating in SPORT. Specifically, this proposal has three research objectives: 1. To characterize clinical practices. We plan a detailed study of variability in structures and processes of care for patients with low back pain at the sites participating in SPORT. 2. To assess outcomes of care. After developing and validating methods for risk-adjustment, we will evaluate and compare quality of care for low back pain across the II sites participating in SPORT. Outcomes, to be assessed in both surgically and non-surgically treated patients, will include functional health status, clinical outcomes, patient satisfaction, and cost. 3. To link clinical practices and outcomes. Using statistical models to account for random variation in the setting of hierarchical data structures, we will examine associations between clinical structure, process, and outcomes to identify high-leverage areas for improvement. Improving clinical care can not occur in the vacuum of a research laboratory. At each step of this project, we will feedback data to clinicians at the participating medical centers and work with them to develop a focused quality improvement agenda that is designed to improve patient outcomes by reducing variability in clinical practices.