Members of the multidisciplinary process improvement team from U.S. Army Medical Department Activity -- Fort Stewart, Winn Army Community Hospital were recognized with the Department of Defense Advancement Towards High Reliability in Healthcare Award for the collaborative development and implementation of standardized treatment procedures for lower back musculoskeletal pain during the AMSUS Banquet in Washington D.C., Nov. 30.

"This was not an Army level award or a MEDCOM level award, but a DoD level award, U.S. Army MEDDAC -- Fort Stewart, Commander Col. Christopher Warner said. "They recognized the best of the best from all hospitals."
Army Medicine is committed to providing the best care where patients want it. To that effort, the committed staff at Winn and outlying clinics has spent the last three years developing a multidisciplinary approach to musculoskeletal treatment. The purpose of new guidelines is to standardize care, and prevent waste of resources utilizing physical therapists from the Department of Rehabilitation to diagnose and treat lower back pain before using radiographic and magnetic resonance imaging (MRI) is deemed necessary.
"Patients would come in with an acute episode of low back pain and providers would order both plain radiographs and an MRI, which incurs cost both to the patient in terms of time spent away from their Family or their job," said Dr. Morgan Williamson, U.S. Army Medical Department Activity -- Fort Stewart, Chief of the Department of Radiology.
In early 2013, a multidisciplinary team consisting of representatives from primary care, radiology, health benefits and rehabilitation, began working on the implementation of robust process improvements, to treatment plans involving lower back pain.
"Our intent was to educate providers, to educate patients, to follow the clinical practice guideline, to ultimately get better outcomes for those patients that are complaining of low back pain," said Maj. Michael Bean, U.S. Army MEDDAC-Fort Stewart, chief of the Department of Rehabilitation.
Educational sessions provided by radiology and physical therapy in early 2014 were aimed at addressing the knowledge deficit providers were experiencing when diagnosing lower back pain, and providing the standardization of the treatment process.

"The research really indicates that early imaging for patients who just have back pain without radiating symptoms is really not effective in treatment and actually drives up not only the cost, but also does involve some risks," Bean said.

In mid-2014, a physical therapist was embedded at Hawks Troop Medical Clinic which provides direct access for the patient to the PT program. The program started as a pilot to address acute musculoskeletal injuries, and now is featured at the Richmond Hill Medical Home, and Tuttle Army Health Clinic.

"They can bypass their primary care manager if their complaint is purely musculoskeletal," Bean said. "That to feeds into evidence based medicine which indicates that early access to rehab tends to produce better outcomes."

One of the main factors assessed during the implementation of the new guidelines for lower back pain was how readiness was affected.

"The Soldier's had early access to physical therapy," said Anita Sachs, nurse consultant, Quality Management Department, MEDDAC. Sachs said this early access helped the Soldiers get back to the frontlines quicker, which had better outcomes on readiness.
As a result of the multidisciplinary process, the HEDIS measurement for lower back pain increased from 10 to the 90 percentile in a 28-month time frame, ensuring Winn's continued commitment to delivering the highest quality healthcare.