It is estimated that 540 million people worldwide are affected by back pain at any one time, while in Australia more than 3.7 million people experienced this type of pain. A study by Monash University, indicated that back pain reduces Australia’s GDP by $3.2 billion a year. Within NSW alone, emergency departments (ED) see 50,000 patients for back pain annually. Of these patients, 70 per cent are given opioids despite known harms, 30 per cent receive unnecessary imaging, and 17 per cent are admitted to hospital. These practices are discordant with guideline recommendations.
The STARS Back Pain App provides ED clinicians with key information relevant to the management of lower back pain, whilst also efficiently providing a mechanism to identify and explore any clinical variation. The app is driving positive changes in clinical practice through audit and continuous feedback, helping to avoid the inappropriate use of tests and treatment for lower back pain, which in the past has included the prescription of dangerous opioids.
Benchmarking the Treatment of Lower Back Pain
To create a benchmark, the team set out to collate a strong dataset of existing options for lower back pain management. Standard information such as patients’ demographics, diagnoses, allied health service review, pain medicines used, pathology tests, diagnostic imaging, costs of care and patients’ admission status are all routinely collected in a variety of electronic medical record systems. Where the STARS Back Pain App differentiates itself is its ability to link these previously siloed data sets in a governed, near real-time manner and present the information back to clinicians through an intuitive interface.
“Building this application in Qlik has brought people in our organization together and started some really valuable conversations. Through the collaboration of our research team with the clinicians and performance unit, we can now see what part of the intervention worked, what didn't, and what we can change moving forward. One of the best things about this app is that each individual can ask their own questions, interrogate the data, and arrive at conclusions without doing extensive and time-consuming audits,” said Dr Bethan Richards, Director of Rheumatology at RPA Hospital who led a multidisciplinary team of clinicians, researchers and IT specialists, to design the STARS Back Pain App.
Information Sharing to Improve Patient Outcomes
In use across three participating emergency departments across NSW including RPA Hospital, Concord Repatriation General Hospital and Canterbury Hospital, the STARS Back Pain App provides clinicians with a summary of patients with lower back pain while highlighting clinical variations. Through access to the app, healthcare professionals can now compare data across hospitals, which ignites conversations about trends, prescription rates and overall patient care.
“With the type of benchmarking now available, clinicians can see how they're performing against other hospitals,” said Charlie Farah, Director, Healthcare & Public Sector APAC at Qlik. “This leads to changes in behavior without intervention. Healthcare professionals have been empowered to start asking questions on their own and debunk myths they have about their performance: Why are we different? Is it that we're getting sicker patients at this hospital versus another hospital? The data initiates a conversation and starts to create its own momentum.”
Initiating Actionable Change
In addition to having access to the data, the SLHD team knew clinicians needed the tools necessary to act on the information and trends they were identifying. A new model of care for back pain was implemented and educational resources for both doctors and patients were created to help encourage the use of other effective, safe, pain management strategies rather than simply using strong opioid medicines. Having access to data also empowered clinicians to provide counsel to their patients on possible treatments and recovery timelines, thus enabling them to make more informed decisions.
“Data can be used for evidence-based management of back pain, which means we can ensure our patients are receiving the best care possible. In addition, clinicians are more likely to use the platform because it gives them a view on their own real-world data. The data is in front of them and ready to be leveraged. The app has already changed the way clinicians in our trial are treating patients,” said Dr Gustavo Machado, Research Fellow at the Institute for Musculoskeletal Health’s NHMRC who led the emergency department trial of the app.
Building on the success of the STARS Back Pain app, SLHD is currently working with the NSW Agency for Clinical Innovation on rolling it out across all NSW emergency departments and has commenced work with Monash University to begin a similar project in Victoria. Moving forward, the District is also looking at other ways to extend the use of technology and analytics outside of back pain to other areas of clinical practice which could benefit from such analytics and insights.