Patient Satisfaction NOT Panacea Re: Measuring Quality
Are we wasting money by over-focusing on patient satisfaction? Probably, say spine researchers from the University of North Carolina and Vanderbilt. The level of a patient’s satisfaction with care is not the whole quality picture, says some illuminating new research. Matthew McGirt, M.D., who served as the primary investigator, is Adjunct Associate Professor at University of North Carolina and a practicing neurosurgeon with Carolina Neurosurgery and Spine Associates in Charlotte, North Carolina. Here, Dr. McGirt tells OTW about the first study that longitudinally tracked patients with scientifically validated patient reported outcome measures of quality and then compared results with patient reported satisfaction with care.
“We have developed the habit of relying on patient satisfaction as a proxy for quality. But we do not actually know if it is a valid measure of overall quality of surgical spine care. A key issue regarding quality is that it must include information on safety, efficiency, and effectiveness of care. While most people agree that patient satisfaction metrics are an important measure of a patient’s contentment with the healthcare experience, we hypothesized that satisfaction with care is not valid standalone measure for overall quality.”
“We found that with regard to surgical spine care, if a patient reported whether they were highly satisfied, highly dissatisfied, or neutral regarding their surgeon, inpatient support staff or outpatient nursing staff, their level of satisfaction not did not correlate with whether they received safe and effective care. From a metrics standpoint that means that you can be a doctor with a lot of complications whose patients are rarely made better by your care, but if you have a great relationship with your patients then they will report being ‘very satisfied’ with their clinical visit or surgical care. Patient satisfaction measures a piece of the quality equation, but it doesn’t address safety, efficiency, and effectiveness. If wasteful care is defined as being expensive care that doesn’t help the patient’s pain, disability, or quality of life, then Quality and Value must be defined using metrics of safety, efficiency, and effectiveness of care. Patient satisfaction, while important, does not address these critical aspects of healthcare value.”
“Thus, by using patient satisfaction as a sole proxy for quality we are defining value as cost for satisfaction and likely misleading the emerging value based reform effort…stakeholders in healthcare reform need to rely on more intelligent solutions.”
Could Genes Point the Way to the Treatment of Hip Arthritis?
Gene expression within the cell just might indicate who will wear out what kind of hip. Neil Sheth, M.D. is an orthopedic surgeon at the University of Pennsylvania in Philadelphia. He tells OTW, “We are beginning to work on the issue of why some people wear out certain hips and others do not. You look at some patients’ X-rays and there is significant plastic wear with minimal bone destruction or osteolysis; with other patients, it is the opposite. This means that each individual may exhibit a different biological response to total hip replacement wear debris. So what if we could identify who will have the wear and tell a patient, ‘Your genetic code predisposes you to osteolysis, so you may be a better candidate for a different type of total hip replacement bearing surface (e.g. ceramic on ceramic).’ The issue is that in order to truly understand this phenomenon, we need a large sample size. This may require a multicenter trial to obtain fluid from patients who have either no wear and bone destruction or those who have wear with no bone destruction so that we can examine the genetic profile of these patients. At present, we are working with basic scientists to develop a protocol to determine gene expression of cells in the synovial fluid obtained from patients with osteolysis. There has been a lot of work on the biological response to wear debris and how to block this medically, but we have not seen work on synovial fluid genetics as it pertains to patients that have osteolysis. We hope to change that.”
Wayne Goldstein, M.D. Wins Alum Award
Wayne Goldstein, M.D., CEO and founder of the Illinois Bone and Joint Institute, was recently honored with the 2013 Distinguished Alumnus Award from The University of Illinois at Chicago (UIC) College of Medicine. Dr. Goldstein graduated from the UIC College of Medicine in 1978. Dr. Goldstein has performed more than 16, 000 joint replacement surgeries and pioneered a total hip replacement technique using a much smaller incision than traditional surgeries. He is a specialist in knee and hip reconstruction and has helped design numerous implants in wide use today. In 1990, he founded the Illinois Bone and Joint Institute, a practice with more than 90 physicians and 20 locations in the Chicago-land area. Goldstein earned his undergraduate degree from the university’s Urbana-Champaign campus in 1974. He did his internship and residency at the UIC College of Medicine and a fellowship at Brigham and Women’s Hospital in Boston.
New Spine Course Brings Together Orthopedists, Physiatrists
It’s a sign of the times. With rising surgical costs and questions about the efficacy of certain spine procedures, some felt it was time to take a different approach. Dan Riew, M.D. is the Mildred B. Simon Professor of Orthopedic Surgery, Professor of Neurological Surgery, and the Chief of the Cervical Spine Service for Washington University Orthopedics and Director of the Orthopedic Cervical Spine Institute. Dr. Riew tells OTW, “I was privileged to participate in a new course run by Ed Dohring, M.D. for the North American Spine Society [NASS]. What made it really novel and exciting was that it brought together spine surgeons and interventional people. The course taught physiatrists and pain specialists the details of surgical anatomy while at the same time instructing spine surgeons and residents on how to do injections. For physiatrists and pain specialists, seeing the internal anatomy can only make them better at navigating a needle percutaneously. It gave surgeons the opportunity to get better at triangulating and putting in a needle. I think there are more spine surgeons doing injections these days because it’s becoming clearer that injections are helpful diagnostically and therapeutically. It can help surgeons make a diagnosis regarding which level to operate on; therapeutically, it can also sometimes help patients avoid an operation.”
Alessandra Berton, M.D. Wins NASS Fellowship Award
Alessandra Berton, M.D. has been honored with the 2013 NASS Research Traveling Fellowship Award. Dr. Berton is with the Department of Orthopaedic and Trauma Surgery at Campus Biomedico University in Rome, Italy. She tells OTW:
“The fellowship will allow me to spend at least five months at the Orthopedic Biomechanics Laboratory of Mayo Clinic in Rochester, Minnesota. While there, I will develop a finite element model of a burst fracture of the thoracolumbar spine instrumented with Moss Miami System (MMS) or MMS with a new device, named Trans-Endplate Pedicle Pillar System (TEPPS) (C. Zhao et al., in press). It has been designed to increase the fixation strength of short-segment pedicle instrumentation (SSPI) and decrease the risk of implant failure.”
“I think I have been selected for this award thanks to the relevance of the project. Burst fractures account for more than 50% of traumatic fractures of the thoracolumbar spine. They can be unstable and require operative stabilization. We expect that this study will not only demonstrate the effectiveness of the TEPPS, but it will provide a general understanding of the biomechanics of thoracolumbar burst fracture instrumented with SSPI.”
“Moreover, the research will be performed thanks to finite element modeling, an innovative technique that is increasing popularity in spine biomechanics research. It can be used to support design and application of spinal instrumentation. Finite element models predict stress distribution and complete the experimental approach. They can simulate a limitless range of conditions and treatment options without performing expensive cadaveric testing. We believe that this study will provide indications to the development of further projects that address the issue of implant research for unstable burst fracture treatment.”
