Assess & Improve the Quality of Care For Low Back Pain

正如本提案的主题所反映的，申请人有两个主要的职业目标：(1)评估手术和非手术治疗腰痛的质量；(2)减少治疗方法的差异，改善这些疾病的治疗效果。这个为期五年的项目结合了结果研究和持续质量改进技术的使用，以缩小通过结果研究和临床实践获得的知识之间的差距，以改善腰痛患者的结果。尽管其频率和相关费用，但对脊柱疾病的护理质量知之甚少。最近启动的脊柱患者预后研究试验（SPORT）提供的数据和基础设施提供了一个独特的机会，可以研究、比较和改善接受三种手术可治疗的脊柱疾病治疗的患者的预后：椎间盘突出、椎管狭窄和退行性脊柱滑脱。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，该试验正在美国医疗中心进行，预计将招募约3000名患者。本提案的总体目标是通过对参与SPORT的医疗中心的护理结构、过程和结果的比较研究来评估和提高腰痛的护理质量。具体而言，本提案有三个研究目标：1。描述临床实践。我们计划对参与体育运动的腰痛患者的结构和护理过程的变异性进行详细研究。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部位腰痛的护理质量。对手术和非手术治疗患者的结果进行评估，包括功能健康状况、临床结果、患者满意度和费用。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领域。改善临床护理不可能在研究实验室的真空中发生。在这个项目的每一步，我们都会将数据反馈给参与医疗中心的临床医生，并与他们一起制定一个重点质量改进议程，旨在通过减少临床实践中的可变性来改善患者的治疗效果。

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.