Abstract
Lumbar fusion is the treatment of choice when neurological function is threatened by spinal instability due to trauma, tumor, infection, or congenital anomalies. The benefits of this procedure are much less certain, however, when lumbar fusion is applied to nonurgent conditions such as chronic back pain without neurologic findings. For this large cohort of patients, high and variable charges, high complication rates, and escalating utilization rate across the United States – coupled with uncertain benefits – have provoked increased scrutiny from purchasers and the provider community alike. The current state is not only costly for purchasers and sometimes dangerous for patients, but it is harmful to the credibility of those providers working to improve the safety, appropriateness, reliability, effectiveness, and affordability of lumbar surgical techniques.
In this chapter we will describe efforts over the last 14 years to improve our approach to lumbar fusion and to ensure that this procedure remains a credible, valuable, and sustainable alternative for those patients likely to receive benefit.
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References
Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of early physical therapy with long-term opioid use among opioid-naive patients with musculoskeletal pain. JAMA Netw Open. 2018;1(8):e185909-e.
Fuhrmans V. A novel plan helps hospital wean itself off pricey tests. Wall Street J. 2007;12:78–92.
Blackmore CC, Mecklenburg RS, Kaplan GS. Effectiveness of clinical decision support in controlling inappropriate imaging. J Am Coll Radiol. 2011;8(1):19–25.
Lee TH, Porter M. The strategy that will fix healthcare. Boston: Harvard Business Review; 2013.
Blackmore CC, Edwards JW, Searles C, Wechter D, Mecklenburg R, Kaplan GS. Nurse practitioner–staffed clinic at Virginia Mason improves care and lowers costs for women with benign breast conditions. Health Aff. 2013;32(1):20–6.
McDonald PA, Mecklenburg RS, Martin LA. The employer-led health care revolution. Harv Bus Rev. 2015;93(7-8):38–50, 133.
Care C. Employer-led innovation for healthcare delivery and payment reform: Intel Corporation and Presbyterian Healthcare Services.
Sethi RK, Pong RP, Leveque J-C, Dean TC, Olivar SJ, Rupp SM. The Seattle Spine Team approach to adult deformity surgery: a systems-based approach to perioperative care and subsequent reduction in perioperative complication rates. Spine Deform. 2014;2(2):95–103.
Ebell MH, Siwek J, Weiss BD, Woolf SH, Susman J, Ewigman B, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. J Am Board Fam Pract. 2004;17(1):59–67.
Robert Bree Collaborative warranty for elective total knee & total hip replacement surgery Washington State 2013. Available from: http://www.breecollaborative.org/wp-content/uploads/bree_warranty_tkr_thr.pdf.
Peterson M, Rolph S. Improving care by redesigning payment. NEJM Catalyst. 2018.
Yanamadala V, Kim Y, Buchlak QD, Wright AK, Babington J, Friedman A, et al. Multidisciplinary evaluation leads to the decreased utilization of lumbar spine fusion: an observational cohort pilot study. Spine. 2017;42(17):E1016–E23.
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Friedman, A.S., Mecklenburg, R.S. (2020). The Bree Collaborative Bundle for Lumbar Fusion: Evolution of a Community Standard for Quality. In: Sethi, R., Wright, A., Vitale, M. (eds) Value-Based Approaches to Spine Care . Springer, Cham. https://doi.org/10.1007/978-3-030-31946-5_3
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DOI: https://doi.org/10.1007/978-3-030-31946-5_3
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