Disorders of the musculoskeletal system present a significant burden to our healthcare economy. Musculoskeletal disorders are the largest cause of disability in the United States, accounting for more than half of chronic disease in patients over age 50 in developed countries.[i] The sum of direct and indirect costs for patients with musculoskeletal disorders in the United States has been estimated to be $849 billion dollars, or 7.7% of the national gross domestic product.[ii] In addition to the financial cost, orthopaedic disorders diminish health-related quality of life. The demonstration of quality and value of care is necessary for defining the role and effectiveness of orthopaedic surgery interventions in the health care economy. The purpose of this proposal is to create an infrastructure to combine administrative data on cost and quality metrics with clinical data on patient-based health status to measure the value of orthopaedic interventions, and to guide changes in care pathways with a goal of optimization of the value of care.
Optimization of value is an important goal of healthcare. Administrative datasets have been useful in measuring quality of care metrics including rates of complication and readmission and in detailing the cost of care. However, administrative data offers little insight into patient preference for health states, change in health status, and the value of care. The approach of integrating clinical outcomes with cost data provides an opportunity for moving beyond the use of process measures alone for measuring quality to providing critical information about the true value of care. This model provides a rational approach to making critical health care decisions and will be an increasing priority as we move towards a value-based health care system.
The Department of Orthopaedic Surgery has the experience and an established infrastructure to routinely collect and analyze health related quality of life outcomes through the Surgical Information Datasystem (SID). We have collected patient-based health status information on over 90% of our elective patients. We have developed methodologies to estimate utilities of health states with the EuroQol 5D, Oswestry Disability Index and the Neck Disability Index. These health status measures permit an estimation of outcome measured in quality adjusted life years (QALYs). Combining administrative data that permits comprehensive identification of cases and costs with patient-centered data will enable us to measure cost per QALY uniformly on orthopaedic cases. Our goal is to develop an infrastructure to combine the clinical outcomes data with hospital administrative data to measure the value of care. This will be accomplished through the creation of a data registry system that integrates clinical outcome and hospital administrative data. The registry will be established in collaboration with a medical informaticist with expertise in creating and implementing integrated data repository architecture that facilitates registry queries for the reporting of quality of care outcomes.
Criteria and Metrics for Success
Processes for reporting value of care metrics will be established at weekly departmental research meetings. Metrics for success will include ability to identify low value interventions and services and establish initiatives to improve the value of these interventions. Assessment of the value of interventions will be guided by demonstration of improvement in outcomes and/or reduction in costs.
Approximate Cost and Justification
$50,000 for the establishment of an integrated registry, staff training, data analysis and reporting.
UCSF Department of Orthopaedic Surgery- Divisions of Arthroplasty and Spine
Sigurd Berven, MD
Steven Takemoto, PhD
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