Embargoed for release until 5 p.m. ET, Monday, January 31, 2011
American College of Physicians Issues
Advice for High-Value Health Care for Diagnostic Imaging for Low Back Pain
Recommendations are first in a series of papers to help physicians and patients identify misused medical
treatments and to practice high-value health care
Video available for diagnostic imaging for low back pain*
PHILADELPHIA, February 1, 2011 -- The American College of Physicians (ACP) has found strong
evidence that routine imaging for low back pain with X-ray or advanced imaging methods such as CT
scan or MRI does not improve the health of patients.
In “Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care from the
American College of Physicians,” published in the February 1 issue of Annals of Internal Medicine, ACP
recommends that routine or advanced imaging studies should only be performed in selected higher-risk
patients who have severe or progressive neurologic deficits, are suspected of having a serious or specific
underlying condition, or are candidates for invasive interventions.
“Low back pain is one of the most common reasons for a patient to see a physician and many
patients with low back pain receive routine imaging that is not beneficial and may even be harmful,” said
Amir Qaseem, MD, PhD, MHA, FACP, director of clinical policy for ACP. “Unnecessary imaging can
lead to a series of unnecessary additional tests, interventions, follow ups, and referrals that do not improve
patient outcomes.”
ACP’s Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care also states:
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Decisions for repeat imaging should be based on the development of new symptoms or changes
in current symptoms.
To be most effective, efforts to reduce routine imaging should take into account clinician
behaviors, patient expectations, and financial incentives.
Patient education strategies should be utilized to inform patients about current and effective
standards of care and help them understand the benefits and harms of the radiological testing.
ACP’s recommendations are based on a systematic review conducted for the Diagnosis and
Treatment of Low Back Pain joint clinical practice guideline from ACP and the American Pain Society,
and a subsequent meta-analysis.
Preserving High-Value, High-Quality Care
In a related paper, “High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate
the Benefits, Harms, and Costs of Medical Interventions,” also published in the February 1 issue of
Annals, ACP explains the purpose of its Advice for High-Value Health Care series: to slow the
unsustainable rate of health care costs while preserving high-value, high-quality care.
“Efforts to control expenditures should not focus solely on the costs, but rather on the value of
health-care interventions,” said co-author Paul Shekelle, MD, PhD, FACP, chair of ACP's Clinical
Guidelines Committee. “The best way to maintain effective and efficient care is to identify and eliminate
wasteful practices, and to demonstrate which interventions provide high-value, which means their benefit
is sufficient to justify their harms and costs.”
The distinction between cost and value (an assessment of whether an intervention provides health
benefits, does have acceptable level of harms, and is worth what it costs) is critical, ACP says; high-cost
interventions may provide good value because the benefits may be large and therefore justify the harms
and costs. Conversely, low-cost interventions may be of little or no value if they provide little benefit.
In the paper, ACP outlines three key concepts necessary for understanding how to assess the
value of health-care interventions:
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It is essential to assess the benefits, harms, and costs of an intervention to understand whether it
provides good value. It is important to reduce the use of interventions that provide no benefit.
Assessment of the cost of an intervention should include not only the cost of the intervention
itself, but also any downstream costs that occur because the intervention was performed.
The incremental cost-effectiveness ratio estimates how much additional cost is required to obtain
additional health benefit, and provides a key measure of the value of a health care intervention.
Health benefit can be measured in many ways, including cases detected or averted, life years
gained, or quality-adjusted life years gained. For interventions that provide additional benefit at additional
cost, ACP recommends assessing their value to patients and society with cost-effectiveness analysis.
Additional Resources:
 Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care from ACP and
Patient Summary
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HEALTH TiP from ACP Foundation
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High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits,
Harms, and Costs of Medical Interventions and Patient Summary
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How Can Our Nation Conserve and Distribute Health Care Resources Effectively and
Efficiently?
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ACP Announces High-Value, Cost-Conscious Care Initiative
About the American College of Physicians
The American College of Physicians is the largest medical specialty organization and the second-largest
physician group in the United States. ACP members include 130,000 internal medicine physicians
(internists), related subspecialists, and medical students. Internists specialize in the prevention, detection,
and treatment of illness in adults. Follow ACP on Twitter and Facebook.
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* Satellite Feed Dates, Times, and Coordinates for "Diagnostic Imaging for Low Back Pain" Video
News Story
Date: Monday, January 31, 2011
Time: 10:30 AM - 10:45 AM Eastern; 9:30 AM - 9:45 AM Central; 8:30 AM - 8:45 AM Mountain; 7:30
AM - 7:45 AM Pacific
C-Band Satellite: AMC 1
Transponder: 9
Downlink: 3880 (H) Audio: 6.2 & 6.8
Date: Monday, January 31, 2011
Time: 2:00 PM - 2:15 PM Eastern; 1:00 PM - 1:15 PM Central; 12:00 PM - 12:15 PM Mountain;
11:00 AM - 11:15 AM Pacific
C-Band Satellite: AMC 1
Transponder: 9
Downlink: 3880 (H) Audio: 6.2 & 6.8
Date: Tuesday, February 1, 2011
Time: 1:30 PM - 1:45 PM Eastern; 12:30 PM - 12:45 PM Central; 11:30 AM - 11:45 AM Mountain;
10:30 AM - 10:45 AM Pacific
C-Band Satellite: AMC 1
Transponder: 9
Downlink: 3880 (H) Audio: 6.2 & 6.8
This story is available on the Pathfire DMG on the News/Video News Feeds Section at D S Simon
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Tab: Medical Story Slug: Low back pain guidelines Story Number: ACP65
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