My back has been hurting over the last month or so. I know that personal health is one of the seven topics we are not supposed to talk about and also that acute low back pain has impacted about one in four of us in the last three months and will impact MOST of us over the trajectory of our lives.

So, what is a busy mother of two young kids who demand to be picked up constantly to do? Here I am unusually lucky in being able to be enmeshed in our region’s health care delivery quality improvement community. I love that our Spine Care Outcomes Assessment Program’s management committee has strategically prioritized including more upstream low back pain data and interventions in the continuum of spine care. I’m looking forward to more conversations on making this a reality.

The Washington Health Alliance’s Driving Value Project, Low-Back Pain Implementation Collaborative is a great resource on how to structure a low back pain care pathway based on the (evidence informed) Bree Collaborative low back pain recommendations. WHA’s priorities include:

• Benefit design changes to best support employee and members returning to function with optimal health outcomes for purchasers;
• Changes to contracts with provider groups to support the use of evidence-based care and patient awareness for plans; and
• Identifying evidence-based practices and supporting changes to workflows that support delivery of high-value care for providers.

Avoiding triggers and prioritizing habits that reduce pain and set me on the pathway to many more (pain-free) years is my plan of action. In a way this is not different than setting up our system for success. As a person (me) must learn to move their body in a more thoughtful, ergonomic way, so does a delivery system have to learn to avoid advanced imaging, specialty care referral, or opioids in the absence of a patient’s red flags.

Of course, my biggest issue with these person-based best practices is time (see aforementioned busy statement) – one of my go-tos is running which requires time on my part and is less fun to do as we move into the rainy, big dark season. Committing to change – on a personal and system level – is hard and requires energy, planning, buy-in, and accountability. Washington state has a fantastic health care quality ecosystem and a supportive running community in addition. As we move into the big dark, we can all commit to building better backs – for ourselves and our community.