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Recommendations are first in a series of papers to help physicians and patients identify misused medical treatments and to practice high-value health care
PHILADELPHIA, February 1, 2011 -- The American College of Physicians (ACP) has found strong evidence that routine imaging for low back pain with X-ray or advanced imaging methods such as CT scan or MRI does not improve the health of patients.
In "Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care from the American College of Physicians," published in the February 1 issue of Annals of Internal Medicine, ACP recommends that routine or advanced imaging studies should only be performed in selected higher-risk patients who have severe or progressive neurologic deficits, are suspected of having a serious or specific underlying condition, or are candidates for invasive interventions.
"Low back pain is one of the most common reasons for a patient to see a physician and many patients with low back pain receive routine imaging that is not beneficial and may even be harmful," said Amir Qaseem, MD, PhD, MHA, FACP, director of clinical policy for ACP. "Unnecessary imaging can lead to a series of unnecessary additional tests, interventions, follow ups, and referrals that do not improve patient outcomes."
ACP's Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care also states:
ACP's recommendations are based on a systematic review conducted for the Diagnosis and Treatment of Low Back Pain joint clinical practice guideline from ACP and the American Pain Society, and a subsequent meta-analysis.
In a related paper, "High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions," also published in the February 1 issue of Annals, ACP explains the purpose of its Advice for High-Value Health Care series: to slow the unsustainable rate of health care costs while preserving high-value, high-quality care.
"Efforts to control expenditures should not focus solely on the costs, but rather on the value of health-care interventions," said co-author Paul Shekelle, MD, PhD, FACP, chair of ACP's Clinical Guidelines Committee. "The best way to maintain effective and efficient care is to identify and eliminate wasteful practices, and to demonstrate which interventions provide high-value, which means their benefit is sufficient to justify their harms and costs."
The distinction between cost and value (an assessment of whether an intervention provides health benefits, does have acceptable level of harms, and is worth what it costs) is critical, ACP says; high-cost interventions may provide good value because the benefits may be large and therefore justify the harms and costs. Conversely, low-cost interventions may be of little or no value if they provide little benefit.
In the paper, ACP outlines three key concepts necessary for understanding how to assess the value of health-care interventions:
Health benefit can be measured in many ways, including cases detected or averted, life years gained, or quality-adjusted life years gained. For interventions that provide additional benefit at additional cost, ACP recommends assessing their value to patients and society with cost-effectiveness analysis.
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 130,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Follow ACP on Twitter and Facebook.