Special issue: Health policyClinical Decision Support and Acute Low Back Pain: Evidence-Based Order Sets
Section snippets
Background
Low back pain is one of the most common reasons for visits to physicians in the ambulatory care setting [1]. In one study, 26.4% of adults reported episodes of acute low back pain within the past 3 months [2]. Although the prevalence of self-reported low back pain has increased only modestly in the past decade, estimated medical expenditures related to back pain have increased substantially [3]. Increased utilization of medical imaging is one component of this cost increase [4, 5]. The total
Evidence-based Clinical Practice Guidelines
Recent efforts have been made to synthesize and summarize the extensive and sometimes confusing literature on the evaluation and management of low back pain [7, 13, 14, 15]. Clinical practice guidelines have been published in the United States [16, 17] and abroad [18], with the aim of decreasing variability, improving the quality of care, increasing patient safety, and encouraging medical care that is based on the best available scientific evidence. Despite differences in culture, local
Clinical Decision Support and Meaningful Use
Clinical decision support (CDS) systems, in general terms, are software applications designed to assist health care providers in decision making throughout the health care process. When used at the order entry stage, these applications provide a unique opportunity to marry evidence-based clinical guidelines with computerized physician order entry systems. Clinical decision support interventions have been in existence for decades, yet there is a lack of widespread adoption in the United States.
Clinical Decision Support Templates for Acute Low Back Pain
Patients with acute low back pain (symptoms lasting <4 weeks) first undergo a thorough history and physical examination, after which they are placed into 1 of 3 broad clinical categories: nonspecific low back pain, low back pain potentially associated with radiculopathy or spinal stenosis, or low back pain potentially associated with a specific cause (Table 1). Order set templates have been devised for the initial visit and follow-up visits for patients falling into each of these clinical
Development and Implementation of Clinical Decision Support Systems
Once the decision has been made to develop a CDS system for acute low back pain, stakeholders are assembled to discuss of the objectives and desired outcome. Common objectives include improving patient care, reducing patient inconvenience, increasing efficiency, and reducing costs. Once consensus has been reached on the objectives and outcomes, the type of CDS application is determined.
The number of decision support applications has grown significantly over time. These applications may be
Discussion
Decision support interventions have the potential to increase clinician speed and efficiency. However, evidence-based order sets have well-known pitfalls that must be taken into consideration [34]. For instance, order sets that are difficult or inconvenient to access may not be used. Once implemented, order sets that are not regularly reviewed and revised quickly become outdated. Additionally, although order sets have many useful features, they typically cannot be sufficiently customized (eg,
Conclusions
We have presented a framework for the development of decision support applications for acute low back pain. At the initial visit, patients are categorized into 1 of 3 groups after a thorough history and physical examination: nonspecific low back pain, low back pain potentially associated with radiculopathy or spinal stenosis, or low back pain potentially associated with a specific cause. Evidence-based order sets are provided for each category that are intended to guide practitioners through
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Software Design Specification Proposal of a Diagnostic Decision Support System for Clinical Low Back Pain
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2018, Cognitive Systems ResearchCitation Excerpt :In this section, we produce a brief review of existing studies and researches related with the decision support system in back pain diagnosis, as well a set of literatures associated with fuzzy-neuro decision support system in some fields of medical diagnosis. For low back pain, Forseen and Amanda (2012) presented and designed evidence-based order templates to assist physicians for acute low back pain process and management. They are presenting, implementing and developing clinical decision support interventions based scientific evidence.
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2017, American Journal of MedicineCitation Excerpt :Additionally, use of inflammatory markers, such as erythrocyte sedimentation rate and C-reactive protein, can help providers determine which patients are more likely to be appropriate candidates for imaging.19,20 Use of clinical decision support tools, including checklists to support diagnostic decision-making, could also be explored.47,48 However, use of these tools requires achieving good diagnostic calibration (ie, an improved relationship between provider's diagnostic confidence and accuracy), and information seeking continues to be a problem, as shown in recent work.49,50
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2015, Journal of the American College of RadiologyCitation Excerpt :However, implementation of imaging CDS does not ensure consistent clinical diagnostic workup and use of evidence-based guidelines. Despite consensus regarding the overuse of lumbar spine MRI for low back pain, specialties vary significantly in the use of imaging for this indication [35-37]. Thus, imaging CDS tools within the computerized physician order entry (CPOE) environment should be a stepping stone on the way to care paths.
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