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Tony Ton-That, M.D.

Lancaster General Health’s innovative, Triple Aim-focused approach to treating low-back pain has won the Hospital & Healthsystem Association of Pennsylvania’s Optimal Operations Award.
Low-back pain is the leading cause of disability in the United States, accounting for nearly 15 million medical visits and $25 billion in healthcare spending annually. One major consequence of the condition, prescription opioid abuse, carries enormous societal burden.
The HAP award recognizes LG Health’s “Transforming Care for Low Back Pain: A New Population Health Model,” a three-year project to develop a systemwide standard of care that reduces opioid prescriptions, unnecessary invasive treatments and imaging services, as well as related costs.
LG Health Physicians and the LGH Emergency Department treat more than 4,000 low-back pain patients each quarter. Variation in treatment, skyrocketing costs and the need for rapid access to effective, evidence-based alternatives led LG Health to prioritize transformation of care for these patients.
LG Health Administrative Director of Neuroscience Joan M. Vance said the new low-back pain protocol creates a standardized, cost-effective approach to care that provides safe and effective pain relief for patients.
“Our goal is to avoid getting patients on opioids,” she said. “So far, we’ve reduced opioid use by 20 percent in the Emergency Department and 10 percent in the family practices. We don’t have to get patients off of opioids when we never get them on.”
Previously many patients with low-back pain received opioids or other addictive medications right away, but still experienced long delays in finding effective care and pain relief. The new protocol calls for physical therapy within 24 to 48 hours, as well as anti-inflammatory medication and patient education.
Tony Ton-That, M.D., LG Health Medical Director of Spine and Low Back Pain, said research shows that early intervention and access to physical therapy can successfully treat pain without the need for opioids or costly imaging tests, which have questionable value for most patients.
“We’re trying to successfully treat acute back pain before it becomes chronic,” Dr. Ton-That said. “Research shows that if you catch patients in the first three months, you win.”
Provider education, including in-person meetings, a CME event, treatment guidelines for ED providers and a real-time Epic dashboard to measure outcomes, is another key to the project’s success.
An Epic smart form now prompts providers to ask specific questions and recommend a standard course of treatment. (The smart form also alerts providers when a patient has “red flags” that warrant imaging or a surgical consult.)  
Patients with pain that persists after four to five PT visits return to their PCP or a specialist for additional treatment, which may include localized injections, non-addictive medications that target nerve pain, cognitive behavioral therapy or acupuncture.
“We want to do what’s best for the patient,” Dr. Ton-That said. “Patient safety is our No. 1 goal.”

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