• National Committee for Quality Assurance (NCQA). HEDIS® 2009: Healthcare Effectiveness Data & Information Set. Vol. 2, Technical Specifications. Washington (DC): National Committee for Quality Assurance (NCQA); 2008 Jul. various p.

Does not apply to this measure

This measure is used to assess percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, magnetic resonance imaging [MRI], computed tomography [CT] scan).

The measure is reported as an inverted rate [1 minus (numerator/denominator)]. A higher score indicates appropriate treatment of low back pain (i.e., the proportion for whom imaging studies did not occur).

Low back pain is a common cause of lost productivity and work days in the U.S. Half of American adults will experience low back pain in any given year; 2 in 3 will suffer low back pain at some point in their life. Low back pain is a common reason for patient visits to the physician. According to the American College of Radiology, uncomplicated acute low back pain is usually benign and self-limiting, and does not call for imaging studies, such as X-rays, magnetic resonance imaging (MRIs) or computed tomography (CT) scans. Most patients return to their usual activities in a month. However, a small portion of this large patient population will need to be evaluated further to investigate more serious health problems.

Imaging studies are frequently overused in the evaluation of patients with acute low back pain. While imaging may be appropriate for patients at risk for more serious conditions, for most patients low back pain is nonspecific with no identifiable cause.

Low back pain; imaging studies (plain X-ray, magnetic resonance imaging [MRI], computed tomography [CT] scan)

Members age 18 years as of January 1 of the measurement year to 50 years as of December 31 of the measurement year, with a Negative Diagnosis History, who had an outpatient or emergency department (ED) visit with a primary diagnosis of low back pain (see the "Description of Case Finding" and the "Denominator Inclusions/Exclusions" fields in the Complete Summary)

An imaging study conducted on the Index Episode Start Date (IESD) or in the 28 days following the IESD (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

Administrative data

Use of imaging studies for low back pain (LBP).

National Committee for Quality Assurance

Unspecified

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

National Quality Forum

Measure was not adapted from another source.

2004 Jan

2008 Jul

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

• National Committee for Quality Assurance (NCQA). HEDIS® 2009: Healthcare Effectiveness Data & Information Set. Vol. 2, Technical Specifications. Washington (DC): National Committee for Quality Assurance (NCQA); 2008 Jul. various p.

This NQMC summary was completed by ECRI on May 25, 2005. The information was verified by the measure developer on December 15, 2005. This NQMC summary was updated by ECRI on January 31, 2007. The updated information was not verified by the measure developer. This NQMC summary was updated by ECRI Institute on February 28, 2008. The information was verified by the measure developer on April 24, 2008. This NQMC summary was updated again by ECRI Institute on March 12, 2009. The information was verified by the measure developer on May 29, 2009.