Qual Manag Health Care. 2000 Spring; 8(3): 42-64.

Application of incremental change strategies in chiropractic and multidisciplinary clinical settings for quality improvement.

Mootz RD, Hansen DT, Souza TA, Triano JJ, Wiese BC.

State of Washington, Department of Labor and Industries, Olympia, USA.

Care for low back pain remains a clinical enigma. Its high prevalence and cost to the system warrants attention for improvement. Although, no major recent clinical breakthroughs for resolving back pain have emerged, reducing unnecessary tests, eliminating useless or harmful practices, preventing care dependence, and enhancing coping skills can be useful goals for improving patient outcomes. Quality Improvement (QI) approaches can serve as bridge between clinical intuition and large scale science. Three chiropractic delivery settings including two teaching clinics and one large multidisciplinary spine care center incorporated QI approaches as part of an initiative to improve low back pain care. All clinics were able to implement sustainable process and outcomes improvements.