Implementing the Keele stratified care model for patients with low back pain: an observational impact study

BMC Musculoskeletal Disorders

Research Article

Ellen Rule¹  Andy Nation²  Susie Durrell²  Adrian Bamford²  Lazaros Andronis³  Hugh McLeod³ 

[1] Gloucestershire Clinical Commissioning Group, Gloucester, UK;Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK;University of Birmingham, Birmingham, UK;

关键词: Low back pain;    Stratified care model;    STarT Back Screening Tool;    IMPaCT Back;    Implementation study;    Physiotherapy;    Economic evaluation;   

DOI  :  10.1186/s12891-017-1412-9

 received in 2016-07-26, accepted in 2017-01-17,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe Keele stratified care model for management of low back pain comprises use of the prognostic STarT Back Screening Tool to allocate patients into one of three risk-defined categories leading to associated risk-specific treatment pathways, such that high-risk patients receive enhanced treatment and more sessions than medium- and low-risk patients. The Keele model is associated with economic benefits and is being widely implemented. The objective was to assess the use of the stratified model following its introduction in an acute hospital physiotherapy department setting in Gloucestershire, England.MethodsPhysiotherapists recorded data on 201 patients treated using the Keele model in two audits in 2013 and 2014. To assess whether implementation of the stratified model was associated with the anticipated range of treatment sessions, regression analysis of the audit data was used to determine whether high- or medium-risk patients received significantly more treatment sessions than low-risk patients. The analysis controlled for patient characteristics, year, physiotherapists’ seniority and physiotherapist. To assess the physiotherapists’ views on the usefulness of the stratified model, audit data on this were analysed using framework methods. To assess the potential economic consequences of introducing the stratified care model in Gloucestershire, published economic evaluation findings on back-related National Health Service (NHS) costs, quality-adjusted life years (QALYs) and societal productivity losses were applied to audit data on the proportion of patients by risk classification and estimates of local incidence.ResultsWhen the Keele model was implemented, patients received significantly more treatment sessions as the risk-rating increased, in line with the anticipated impact of targeted treatment pathways. Physiotherapists were largely positive about using the model. The potential annual impact of rolling out the model across Gloucestershire is a gain in approximately 30 QALYs, a reduction in productivity losses valued at £1.4 million and almost no change to NHS costs.ConclusionsThe Keele model was implemented and risk-specific treatment pathways successfully used for patients presenting with low back pain. Applying published economic evidence to the Gloucestershire locality suggests that substantial health and productivity outcomes would be associated with rollout of the Keele model while being cost-neutral for the NHS.

【 授权许可】

CC BY   
© The Author(s). 2017