Spine Clinic Innovating and Spreading Better Care Andrew Friedman MD AAPM&R Innovations in Spine...
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Spine Clinic Innovating and Spreading Better Care Andrew Friedman MD AAPM&R Innovations in Spine Care Summit October 2, 2015
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Transcript of Spine Clinic Innovating and Spreading Better Care Andrew Friedman MD AAPM&R Innovations in Spine...
Spine ClinicInnovating and Spreading Better Care
Andrew Friedman MD
AAPM&R Innovations in Spine Care SummitOctober 2, 2015
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Current State—The Problem StatementCurrent State—The Problem Statement
Musculoskeletal Pain Costs
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Breakdown of Costs:
Diagnostic procedures
Back surgery
Physical therapy
Medication
Physician evaluation
Spine Clinic Design
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© 2014 Virginia Mason
Goals of Spine Clinic
• Quick access for the patient• The ‘right’ care at the ‘right’ time• Evidenced based care• High patient satisfaction• Quick return to function• Win for patient, win for employer, win for payer
and win for us
© 2014 Virginia Mason Medical Center
Patient Priorities Patient Priorities
1. Reassurance no serious disease2. Relief of symptoms3. Rapid return to function
– Patient priorities in complicated cases include management of disability claims, legal claims, ongoing symptoms, suffering
© 2014 Virginia Mason Medical Center
Evidence-based appropriate careEvidence-based appropriate care
© 2014 Virginia Mason
Spine Clinic Appointment Sorting• Series of questions asked of the patient
chief complaint red flag symptoms mechanism of injury date of onset previous evaluation previous diagnostic studies previous diagnosis previous treatment co-morbidities referral for care
• Each response is weighted based upon clinical relevance• Based upon the patient response as score is assigned that
correlates to the clinic that the patient will be scheduled into. 0-15 Acute Spine Clinic – 60 minutes with PT and 20 minutes with MD 15+ Physical Medicine Consultation - 60 minutes with MD (no PT)
© 2014 Virginia Mason Medical Center
Flow of visitFlow of visit
© 2014 Virginia Mason Medical Center
07:5
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Patient 1 FM FM
PT
MD
Patient 2 FM FM
PT
MD
Patient 3 FM FM
PT
MD
Patient 4 FM FM
PT
MD
Patient 5 FM FM
PT
MD
Patient 6 FM FM
PT
MD
Patient 7 FM FM
PT
MD
PT
MD
PT
MD
PT
MD
PT
MD
PT
MD
PT
MD
PT
MD
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Outcomes
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The New Approach
Back pain best practice
SOURCE: Fuhrmans, Vanessa. "A Novel Plan Helps Hospital Wean Itself Off Pricey Tests." The Wall Street Journal. N.p., 12 Jan. 2007. Web. 04 Aug. 2015. <http://www.wsj.com/articles/SB116857143155174786>.
Results
55% reduction in spend per episode of back pain
1/3 fewer diagnostic imaging procedures performed
67% fewer missed days of work 91% patient satisfaction
Details
Same day access for patients Concurrent visits with doctors and
physical therapists Over-the-counter pain medicine and
structured follow-up Downstream referral if red flag symptoms
© 2014 Virginia Mason Medical Center
Evidence-based ImagingLower Utilization Without Pre-authorization
Evidence-based ImagingLower Utilization Without Pre-authorization
Headache: -23%Low back pain: -23%Sinusitis: -27%
Mistake-proofing Implemented
Reduction in imaging
J Am Coll Radiol 2011;8: 19-25.
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© 2014 Virginia Mason Medical Center
Disc Decompression 2007-2010Disc Decompression 2007-2010
More Consistent
Less Consistent
More Intense Less Intense
The Bigger Picture
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© 2014 Virginia Mason Medical Center
S
Step Two
Step Three
Stepped-Care ModelStepped-Care Model
© 2014 Virginia Mason Medical Center
Stepped Care Stepped Care
•Step 1—most patients. Low-cost intervention which addresses fears and encourages return to normal function•Step 2—targets patients who need more than simple advice to resume activities. Brief structured interventions•Step 3—targets pts who require more intensive interventions including treatment of psychological illness before they can return to work/family activities
© 2014 Virginia Mason Medical Center
Stepped Care ModelStepped Care Model
• Requires accurate stratification• Relies on Patient Measurement• Captures greater value for complex
patients• Key to population managment
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