OHLC

Evidence-Based Best Practices initiatives develop strategies to reduce costs and improve the quality of care for patients with consistent use of proven clinical guidelines in high cost medical areas.

The workgroup consists primarily of physicians, focused on conditions for which there are existing evidence-based clinical guidelines and initiatives are already underway in Oregon; and where there are known practice variations in Oregon, compared to U.S. benchmarks.  The focus is on implementing practices and evidence-based guidelines that have the potential to offer a major cost impact and improve quality.

2011 brought new focus on creating a community standard for reducing elective deliveries before 39 weeks. And in January 2012, the workgroup launched a new pilot program to address the management of acute low back pain that offers access to physical therapy within two business days. The workgroup has also been discussing standards of care for opiate prescribing to reduce their inappropriate use.

Updates on our work:

Acute Low Back Pain Management

On Jan. 1, the Council launched a two-year initiative to allow direct access to physical therapists for patients with uncomplicated acute low back pain. The pilot is being offered to fully insured and self-insured commercial members of Cigna, Lifewise, ODS, PacificSource, Providence, Regence and UnitedHealthcare as well as employees of other hospital system Council members – Asante, Providence, Salem Health and St. Charles Health.

The pilot is a community-based approach to a standardized care process for the identification and treatment of patients with acute low back pain. The goal is to reduce loss of work time, improve the functional status and satisfaction of the patient, and reduce downstream medical costs. The care process uses a standardized screening tool to identify patients that would benefit from the care and offers appointments within 24 to 48 business hours. Focusing on exercise, education and self-management tactics, physical therapists representing more than 70 locations with more than 250 therapists will participate. Since our last report, we have been working with the health plans, major business associations and the Oregon Coalition of Health Care Purchasers and Oregon Health Care Quality Corporation to spread the word of this opportunity.

Learn more about the Low Back Pain pilot

Reducing Elective Deliveries Before 39 Weeks

Work continues in hospitals throughout the state to reduce the rate of elective deliveries occurring before 39 weeks. As of the end of March, the March of Dimes reports there are now 33 hospitals that have put in place, or have committed to implement, the new community-wide standard to place a “hard stop” on non-medically indicated early deliveries at their institutions. The Oregon hospitals are: Adventist, Asante, Blue Mountain, Columbia Memorial, Good Shepherd, Harney District Hospital, Kaiser Permanente, Legacy, OHSU, Peace Harbor, PeaceHealth, Providence, Salem Health, Samaritan Health, Sky Lakes, and Tuality. With a hard stop, elective deliveries will no longer occur before 39 weeks unless there is clear medical evidence to the contrary. To support this effort, the March of Dimes has sent out more than 12,000 pieces of consumer material to the hospitals. In addition, OHSU has been working on ways to measure the effectiveness of the effort.

Reducing the Inappropriate Use of Opiates

In January, the committee reviewed work being proposed by the Oregon College of Emergency Physicians (OCEP) to implement statewide guidelines on the appropriate use of prescribing narcotics in emergency departments. Using guidelines implemented in Washington state, the OCEP has been working with different physicians, hospitals and emergency room nurses to finalize guidelines and garner support for implementation of these guidelines statewide. The work group will be recommending to the Council that they consider supporting the OCEP effort as a first step in addressing this major issue in Oregon.