The Best Practices Project was launched to improve the quality of care delivered to our patients through the development of standardized care pathways for three common spinal procedures: Microdiscectomies (MLD), Lumbar Fusions (LF) and Cervical Fusions (CF). As a part of this effort, all physicians follow up with patients in the same manner regarding number of follow-up visits, when/what imaging to get, and when to prescribe Physical Therapy. Patient outcome data is collected pre-operatively and at 1 week, 1 month, 3 months and 1 year post-surgery. Outcomes investigated include pain levels, symptomology, disability, mobility, return to work status, and prescription pain medication usage. Complications and other key surgical data such as fusion status are also tracked. Patients are categorized based on their progress after surgery and their adherence to our predetermined workflow. Since January 2018 we have aggregated data for over 600 patients and over 1000 post-operative visits.
All outcome data is regularly analyzed and published internally. Over the past three years we have seen that our MLD, LF and CF fusion patients exhibit improved mobility and clinical outcomes over all four postoperative time points. A study examining the impact of patients’ pre-operative history showed that lumbar fusion patients who exercised more frequently before surgery were more likely to return to work after surgery. This study was presented at the 2020 Spine Summit: Focus on Data Driven Innovation Annual Meeting. Since June 2020, all data collection/analysis has been fully automated through the use of an app-less SMS-based electronic patient-reported-outcome-tool. The tool uses SMS surveys to instantly connect with patients and allows physicians to be immediately alerted of patient issues. There is an associated web portal allowing for data viewing and analysis. Our data capture rate has doubled since we started using SMS surveys (SMS: 52%, Non-SMS: 26%), and use of the tool has reduced the amount of time required to collect outcomes by two-thirds. An abstract of these results was accepted for publication in The Spine Journal and will be presented at the 2021 North American Spine Society Annual Meeting and American Association of Neurological Surgeons Annual Meeting.
The Best Practices Project aims to improve the value of care we deliver to our patients by focusing on patient-centered outcomes and standardizing each phase of a patient’s episode of care. In the near future we plan to build a predictive model to proactively identify those patients who are at the highest risk of poor outcomes.