A hospital-based standardized spine care pathway: report of a multidisciplinary, evidence-based process

J Manipulative Physiol Ther. 2011 Feb;34(2):98-106. doi: 10.1016/j.jmpt.2010.12.004.


Objective: A health care facility (Jordan Hospital) implemented a multidimensional spine care pathway (SCP) using the National Center for Quality Assurance (NCQA) Back Pain Recognition Program (BPRP) as its foundation. The purpose of this report is to describe the implementation and results of a multidisciplinary, evidence-based, standardized process to improve clinical outcomes and reduce costs associated with treatment and diagnostic testing.

Methods: A standardized SCP was developed to improve the quality of back pain care. The NCQA BPRP provided the framework for the SCP to determine the standard of quality care delivered. Patients were triaged, and suitable patients were categorized into 1 of 5 classifications based upon history and examination, directional exercise flexion or "extension biases," spinal manipulation, traction, or spinal stabilization exercises.

Results: The findings for 518 consecutive patients were included. One hundred sixteen patients were seen once and triaged to specialty care; 7% of patients received magnetic resonance imagings. Four hundred thirty-two patients (83%) were classified and treated by doctors of chiropractic and/or physical therapists. Results for the patients treated by doctors of chiropractic were mean of 5.2 visits, mean cost per case of $302, mean intake pain rating score of 6.2 of 10, and mean discharge score of 1.9 of 10; 95% of patients rated their care as "excellent."

Conclusions: By adopting the NCQA BPRP as an SCP, training physicians in this SCP, and using a back pain classification, Jordan Hospital Spine Care demonstrated the quality and value of care rendered to a population of patients. This was accomplished with a relatively low cost and with high patient satisfaction.

MeSH terms

  • Evidence-Based Medicine*
  • Exercise Therapy
  • Health Care Costs
  • Hospitals, Community*
  • Humans
  • Low Back Pain / classification
  • Low Back Pain / therapy*
  • Manipulation, Chiropractic* / economics
  • Middle Aged
  • Patient Satisfaction
  • Physical Therapy Modalities* / economics
  • Quality Assurance, Health Care
  • Traction
  • Triage