Hartford (Conn.) HealthCare is building a systemwide “spine dashboard” to track how its surgical and nonsurgical spine patients fare over the long term, as spine surgery faces fresh questions about its value.
On Sept. 24, The Economist published an editorial arguing that back and shoulder surgery is often worse than useless and that millions of operations should be scrapped. Five days later, Vijay Yanamadala, MD, responded in a column for Becker’s, arguing that spine surgery can answer its critics only with its own data. Dr. Yanamadala is vice chair of neurosurgery for St. Vincent’s Medical Center in Bridgeport, Conn., and the Fairfield region at Hartford HealthCare, as well as the system’s medical director for neurosurgery quality, research and innovation.
“Where we go amiss in this country, I think, is really following patients long term, both surgical and nonsurgical, and understanding are they doing well, or are they not?” Dr. Yanamadala said in an interview with Becker’s. “And this is where we are creating a systemwide spine dashboard across all of our hospitals, orthopedics and neurosurgery for spine care, to basically assess our standards and to create one uniform standard across the system whereby we judge the success of both surgical and nonsurgical spine care.”
Dr. Yanamadala said the spine dashboard gives the health system a single view of every spine patient it treats. The tool collects information automatically from patient records and patient surveys. From there, leaders can monitor how often patients develop complications or infections after surgery, how often they return to the hospital, how they rate their own recovery, and how long and how costly procedures are.
That work starts with not treating surgical volume as the measure of success, even if it means performing fewer operations.
“Traditionally, large health systems can be judged by surgical volumes,” he said. “But that’s very shortsighted.”
That approach runs against the grain of fee-for-service payment, Dr. Yanamadala said.
“Our goal is to provide a spine program built on a consumer-centric model, one that measures what is meaningful to patients, including patient-reported outcomes and each patient’s own goals, rather than volume alone,” he said. “Given the rising cost of care across the country, we have a responsibility as a system to deliver the right care in the most affordable way.”
Spine programs are commonly judged on CMS quality measures such as readmissions and complication rates.
“They don’t get at the ultimate question, which is, have we actually solved this patient’s problem?” Dr. Yanamadala said. “And that’s where patient-reported outcomes have really come into play.”
Patient-reported outcome measures, such as the Oswestry Disability Index and PROMIS, ask patients to rate their own pain and function
“Patient-reported outcomes have their place, and they’re very important, and they need to be collected,” he said.
But standard patient-reported outcome tools still miss what each patient actually wants, he said.
“We have to go one step deeper,” he said. “At Hartford HealthCare’s Ayer Neuroscience Institute, we actually ask, what is that patient’s goal, and can you state that in a sentence? That’s a measure that isn’t yet routinely part of how spine programs judge success.”
Before any care is delivered, patients are asked what they hope to be able to do after treatment, whether or not that treatment involves surgery.
“Is it to carry your grandchild again? Is it to go and walk for two miles a day like you used to be able to do?” he said. “These are all very individual questions that no patient-reported outcome metric really measures, yet that’s probably the single-most important metric when it comes to the patient’s own success.”
The team tracks patient outcomes.
“Our approach is to ask after a surgery or after any nonsurgical care: Have we met that goal? To what extent have we met that goal?” he said.
At Hartford HealthCare’s Spine Wellness Center in Westport, Conn., neurosurgeons work under one roof with pain specialists, physiatrists, neurologists, physical therapists and acupuncture specialists. Spine care in the U.S. is too often siloed, Dr. Yanamadala said, with pain physicians giving injections to patients who would benefit from surgery, or surgeons operating on patients who would have done better with injections or physical therapy.
“You come to an integrated center and get the right care that you need from the clinician who’s going to provide it, and that’s the model that we’ve built here,” he said.
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