Skip to main content

Sarah Cunningham DO

  • Graduate 2020
Scholarly Research Project

Screening for Modifiable Risk Factors in Patients with Chronic Low Back Pain: A Quality Improvement Study

Sarah Cunningham, DO; Stephanie Richards, MD; Lindsay Nakaishi, MD, MPH; Phillip Phelps, LCSW; Cynthia Salter, MPH


Chronic low back pain (CLBP) is a common problem that primary care physicians face in patients. Shemory et al (2016) conducted a retrospective cohort study of 1.2 million patients and concluded that patients with tobacco use, obesity, depression, or alcohol use disorder had a positive relative risk for developing CLBP. The purpose of this QI project was to improve screening for modifiable risk factors (MRFs) in patients with CLBP at the Shadyside Family Health Center (SFHC).


QI approval was obtained. A retrospective chart review found 341 patients diagnosed with CLBP. 183 patients were not screened for MRFs. Some patients have multiple MRFs. Additionally, observational data of 200 charts showed inconsistent billing. The intervention was a dotphrase used in Epic to screen for MRFs. Handouts were created for both physicians and patients, which included resources for patients and physicians for each MRF. Physician handouts included counseling information and ICD-10 billing codes. Data collection spanned 1/2019 through 11/2019. After nine months of dotphrase implementation, providers were surveyed about barriers when using the dotphrase.


106 CLBP patients were screened for MRFs. Obesity was both the most prominent MRF (53.8%, n=57), and least consistently billed (38%, n = 22). Alcohol was the least prominent MRF (6.6%, n=7). The barriers to dotphrase use survey revealed (89%, n = 17) of providers were frustrated with limited management options for CLBP patients. The most common reason for not using the dotphrase was forgetfulness (84%, n=10). 


Screening rates increased for MRFs in patients with CLBP with the use of a dotphrase that delivered relevant handouts. Providers did not improve billing for these comorbidities. The dotphrase remains in place for providers. Separate projects for alcohol use disorder will continue in future resident projects.