INTRODUCTION:
Low back pain was the 5th most common reason for an emergency department (ED) visit in 2020–21 in Australia, with >145,000 presentations; one third of these patients were subsequently admitted to hospital. Admitted patient care accounts for half of the total healthcare expenditure on low back pain in Australia.
AIM:
The primary aim of the Back@Home study is to assess the effectiveness and feasibility of implementing a virtual hospital model of care to reduce length of admission in people presenting to ED with musculoskeletal LBP. Secondary aims are to reduce rates of traditional hospital admission from the ED, as well as re-presentations and readmissions to the traditional hospital. We also aim to demonstrate non-inferiority of patient-reported outcomes, such as satisfaction with care.
METHODS:
We plan to conduct an interrupted time series study at three metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years and over with a primary diagnosis of musculoskeletal low back pain presenting to emergency departments. The implementation strategy includes clinician education utilising multimedia resources, staff champions, and an ‘audit and feedback’ process. Implementation of ‘Back@Home’ will be evaluated over 12-months, and compared to a 48-month pre-implementation period, using monthly time-series trends in average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the pre-implementation period. Linear segmented regression will identify changes in level and slope of fitted lines, indicating immediate effects of the intervention, as well as effect over time. Patient reported outcome and measures and experience measures will be collected.
RESULTS:
Preliminary results will be analysed 6 months post implementation and presented at the conference. As of July 2023, 43 patients have participated in the Back@Home service, avoiding hospital admission. None have required escalation of care, or experienced adverse events.
CONCLUSION:
A robust study design will be used to evaluate a novel model of care implementation for low back pain, combining an interrupted time series, patient reported outcomes, as well as process and cost effectiveness evaluations.