Collaboration is the essence of Partners HealthCare’ mission. Across our nine hospitals and 6,000 physicians, efforts are underway—every day—to enhance quality for our patients through interdisciplinary partnerships that uncover new insights and strengthens our standards of care. From time to time, we highlight specific ways that our clinical collaboration is benefitting the care we deliver for conditions that most impact our patients.
Among spinal surgeries, fusion procedures for lumbar spine disorders such as stenosis are exceedingly common—and costly. Though these procedures comprise a common framework—minimize pressure on the nerves, stabilize the spine, introduce any necessary implants such as screws or plates for stabilization—substantial variety can be found among surgical approaches and surrounding care. This variety can impact the outcomes and cost of care, making spinal fusion procedures the ideal starting point for the Partners HealthCare Orthopedics and Neurosurgery Collaborative, which launched in the summer of 2016.
At its first annual Spine Surgery Symposium last June, that goal took shape with an interactive discussion examining variations in care and outcomes-enhancing strategies across the surgical continuum, including:
• Preoperative Factors: How patient population variations such as duration of symptoms and prior treatment modalities, and standards of care such as premedication strategies, impact outcomes
• Intraoperative Factors: The length and costs of surgery, and how specific techniques and practice patterns, such as bone graft substitution, impact those factors
• Postoperative Factors: How standards of care related to opioid prescription duration and dose, physical therapy, and early mobilization may impact the length of stay and outcomes
“The nature of Partners’ system enables us to gather a wide range of surgeons—young and experienced, from private and hospital-based practices—in a uniquely collaborative way,” says co-chair Louis Jenis, MD.
Dr. Jenis adds that as the collaborative expands its focus into other spinal conditions and looks ahead to its second symposium, their ultimate goal is not simply to reduce costs and improve quality by traditional measures, but to enhance the patient experience as measured by the patients themselves. By collecting Patient-Reported Outcome Measures (PROMs) over time, the surgeons can better understand how patients’ function, pain, and mobility improve with adjustments in surgical practice. And that, Dr. Jenis says, is ultimately what matters most.
“Asking patients how they are doing, before and after surgery, gives us the clearest view into what is the most appropriate, necessary care—and how we can remove unnecessary care that is wasteful or even harmful,” he adds.