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## Complete Summary

#### TITLE

Adult low back pain: percentage of acute low back pain patients without
red flag indicators undergoing anterior-posterior (AP) or lateral (LAT)
x-rays.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Adult low back pain.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2006 Sep. 65 p. \[124 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients with acute low
back pain without red flag indicators undergoing anterior-posterior (AP)
or lateral (LAT) x-rays.

#### RATIONALE

The priority aim addressed by this measure is to reduce unnecessary
imaging studies in patients with acute low back pain.

#### PRIMARY CLINICAL COMPONENT

Acute low back pain; x-ray (anterior-posterior \[AP\], lateral \[LAT\]);
red flag indicators (see the \"Denominator Inclusions/Exclusions\" field
in the Complete Summary)

#### DENOMINATOR DESCRIPTION

Number of patients who present to clinic with low back pain six weeks or
less without red flag indicators (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Number of patients receiving anterior-posterior (AP) or lateral (LAT)
x-rays. Include only patients who meet the criteria for the denominator.

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Adult low back
    pain.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9863)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients who present to the clinic with acute low back pain

Identify patients with acute low back pain using diagnosis codes (see
the \"Denominator Inclusions/Exclusions\" field). Patients should be
included if the onset of symptoms was six weeks or less.

The medical record of each patient is reviewed to determine if the
patient meets any of the red flag indicators (see the \"Denominator
Inclusions/Exclusions\" field). If none of the red flag indicators are
present, the chart is further reviewed for use of anterior-posterior
(AP) or lateral (LAT) x-ray.

The suggested time period for data collection is a calendar month.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients who present to clinic with low back pain\* six weeks
or less without red flag indicators\*\*

\*Patients who are within six weeks of onset of low back pain and
related symptoms, as identified by the following International
Classification of Diseases, Ninth Revision (ICD-9) codes: 720.x, 721.x,
722.x, 724.xx, 847.2, 738.4, 738.5, 738.6.

\*\*Lumbar spine x-rays should be considered when the following red flag
indicators exist:

-   Unrelenting night pain or pain at rest (increased incidence of
    clinically significant pathology)

-   Fever above 38 degrees C (100.4 degrees F) for greater than 48 hours
    without obvious cause

-   Progressive or new onset of neuromotor or sensory deficit (computed
    tomography \[CT\] or magnetic resonance imaging \[MRI\] may be the
    preferred imaging)

-   Pain with distal numbness or leg weakness

-   Loss of bowel or bladder control (retention or incontinence)

-   Clinical suspicion of ankylosing spondylitis

-   Significant trauma (accident or injury other than twisting or
    lifting injury unless other risk factors are present)

-   History of or suspicion of cancer

  Other conditions that may warrant anterior-posterior (AP) or lateral
(LAT) x-rays:

-   Over 50 years old (increased risk of malignancy, compression
    fracture)

-   Failure to respond after 6 weeks of conservative therapy

-   Drug or alcohol abuse (increased incidence of osteomyelitis, trauma,
    fracture)

**Exclusions**\
See \"Inclusions\" above.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of patients receiving anterior-posterior (AP) or lateral (LAT)
x-rays. Include only patients who meet the criteria for the denominator.

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a lower score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Percentage of acute low back pain patients without red flag indicators
undergoing AP or LAT x-rays.

#### MEASURE COLLECTION

[Adult Low Back Pain
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=4454)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2003 Sep

#### REVISION DATE

2006 Sep

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Adult low back pain. Bloomington (MN): Institute for
Clinical Systems Improvement (ICSI); 2005 Sep. 64 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Adult low back pain.
Bloomington (MN): Institute for Clinical Systems Improvement (ICSI);
2006 Sep. 65 p. \[124 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of patients with acute low back
pain receiving AP or LAT x-rays,\" is published in \"Health Care
Guideline: Adult Low Back Pain.\" This document is available from the
[Institute for Clinical Systems Improvement (ICSI) Web
site](http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/).

For more information, contact ICSI at, 8009 34th Avenue South, Suite
1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web
site: [www.icsi.org](http://www.icsi.org/); e-mail:
<icsi.info@icsi.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI on May 4, 2004. This NQMC
summary was updated by ECRI on October 14, 2004, November 3, 2005, and
again on December 6, 2006.

#### COPYRIGHT STATEMENT

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\[ICSI\] Measure) is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/10/2008