The cost of health care in the United States continues to escalate rapidly. In addition, there is evidence of substantial variation in medical practices and growing concern about the quality of medical care. These trends have led to increasing interest in the development of practice guidelines to assist clinicians in the care of their patients. Many groups, including AHCPR, are actively developing clinical guidelines for primary care clinicians. It remains unclear, however, to what extent primary care physicians will accept and follow such guidelines. Moreover, the most effective methods for the dissemination and implementation of clinical guidelines in primary care settings have not been established. Acute low back pain is one of the most common conditions seen in the primary care of adults. Furthermore, the evaluation, treatment, and disability associated with this condition make it one of the most costly medical problems facing the United States population. The care of acute low back pain, a generally benign condition, involves a substantial amount of discretionary utilization of medical services leading to significant practice variations and potential over-utilization of scarce medical resources. This proposal describes a detailed effort to determine the effect of a clinical guideline for the treatment of acute low back pain. The effect of patient education with or without guideline implementation on these endpoints will also be assessed. A formal cost analysis of the implementation methods will be undertaken. The study will evaluate alternative guideline implementation methods in a controlled, comparison of primary care clinician practice groups in an HMO setting. The impact of guidelines on clinician practices, utilization of medical resources, patient satisfaction and functional outcomes will be the endpoints of interest in this study.
