Value-Based Approaches to Spine Care : Sustainable Practices in an Era of Over-Utilization

Unsustainable healthcare costs and sophisticated predictive modeling based on large-scale medical data is rapidly changing models of healthcare delivery. The shift towards a value-based, consumer-driven industry has created an urgent need for validated tools to increase cost efficiency, reduce rates of adverse events, and improve patient outcomes. Value-based approaches to spine care will be presented, highlighting models for the future. These approaches stress cost effectiveness and sustainable approaches to spinal disease, where quality and safety are paramount.  Beginning with a review of current trends in health care delivery leading to more value-based platforms, the discussion then focuses on how modern spine care is being shaped by the aging population, scientific and technological advancements, and the economic impact of various treatment modalities, providing insight into the seminal efforts surrounding sustainable spine care guideline development. The over-utilization of spine fusion surgery and adult spinal deformity are presented as examples that have led to a decline in the value of care delivered, as well as how a multidisciplinary evaluation by the range of clinicians involved in spine surgery can revise recommendations for management. The benefits and risks of LEAN methodology for streamlining and standardizing spine care approaches are discussed, and the specific approach of the Seattle Spine Team is presented as an example of successful system-wide improvement. Similar changes to outcome measurement, specifically for adult spinal deformity, are described. Last, the future of technology in spine care is presented, including robotics, nanotechnology, 3D printing, and the use of biologics and biomaterials. Given the broad scope of topics covered in this book, the intended audience includes not only orthopedic and spinal surgeons, neurosurgeons, physiatrists, and medical students, residents and fellows, but also hospital CEOs, CMOs, administrators, health services researchers, and health care policymakers, consultants and strategists.