Issue link: https://beckershealthcare.uberflip.com/i/1120168
25 Executive Briefing Sponsored by: T reating back pain creates significant challenges for hospitals and health systems across the country, and these challenges will likely become even more pressing in the next 10 years. 1 Every year, an estimated 700,000 people in the United States suffer from vertebral fragility fracture (VFF), a condition that can diminish mobility and cause severe pain in some osteoporosis cases. Incidence of VFF is likely to rise in the U.S. as the nation's population ages. In fact, previous research projected the volume of overall fragility fractures to increase by 50 percent between 2005 and 2025. 2 Caring for patients with fragility fractures is expensive. These patients often arrive in the emergency department (ED) and require extensive hospital stays and rehabilitation. In 2015, medical care associated with VFF alone reached an estimated $1.2 billion in the U.S. 3 In addition to being expensive, VFF can also be clinically challenging. Symptomatic patients often experience complications that are associated with a sedentary lifestyle, including pneumonia and loss of muscle or body mass, falls, deep venous thrombosis and depression. 4 These symptoms are similar to nonspecific back pain and can lead to misdiagnosis and treatment. In many cases, radiologists and physicians without a musculoskeletal background fail to identify VFF on the radiology reports and to appropriately address the patient's osteoporosis. 5 For example, an ED physician treating a patient with debilitating back pain may write a prescription for opioids to mask the symptoms instead of fixing the problem. As a result, the patient may experience temporary pain relief, but may return for additional intervention when the prescription is up, risking their fracture to worsen in the interim. However, that same ED physician can avoid treatment delays by recognizing the symptoms of VFF, ordering an MRI and referring the patient to a musculoskeletal specialist, as needed. The musculoskeletal specialist can then diagnose VFF and develop a treatment plan with the patient; whether that's conservative management or surgical intervention. "In this day and age when everyone is concerned with their healthcare dollars and value-based medicine, we need to make sure we are delivering the appropriate care for back pain," Thomas Andreshak, MD, a Bowling Green, Ohio- based orthopedic surgeon with Consulting Orthopaedic Associates, said. "If we can provide education to ED physicians and recommend treatment algorithms, we can help further differentiate who needs advanced care and become better care providers." To meet the needs of VFF patients and help individual providers overcome challenges associated with treating the condition, hospitals should consider integrating a clinical care pathway designed to ensure these patients receive swift, quality care. Clinical care pathway development A group of clinicians with expertise in neurosurgery, interventional radiology, pain management and orthopedic surgery used the RAND™/UCLA Appropriateness Method to design a clinical care pathway for VFF patients. 6 The RAND/UCLA method is a process that brings together specialists from multiple backgrounds to determine best practice guidelines. The panel of clinicians concluded that patients presenting with severe back pain should undergo an MRI to identify a potential fracture and then be entered into a personalized treatment plan, which may include nonsurgical treatment options such as bed rest, analgesics and bracing. In 2018, they published these On the road to success with back pain patients suffering from vertebral fragility fractures: An evidence-based clinical care pathway Thomas Andreshak, MD Orthopedic Surgeon Consulting Orthopaedic Associates