Measuring the Quality of Spine Care at the Cedars-Sinai Spine Center

Cedars-Sinai is committed to the latest spine expertise, treatment and research. As a result, the Cedars-Sinai Spine Center has developed into a comprehensive and advanced spine center dedicated to the evaluation, diagnosis and treatment of all neck, back pain and spinal conditions.

The Cedars-Sinai Spine Center has a multidisciplinary team of surgeons, surgical fellows, specialized spine nurses, and conservative care and diagnostic specialists.

Research and teaching are emphasized by the Center that help us to provide the most state-of-the-art clinical care available. Numerous clinical trials are being conducted and developed to pursue the latest techniques available to create the most effective treatments to alleviate back and neck pain. The Center is currently conducting clinical trials in artificial disc replacement to treat pain and disability caused by cervical and lumbar disc disease. Other current studies include non-fusion devices for spinal stabilization, bone morphogenetic protein applications for enhancing the success of spinal fusion, Facet joint replacement  and laboratory research involving biomechanics and biotechnology for spinal regeneration.

Our goal is to ensure that all patients are cared for with respect and efficiency through their course of treatment for their spinal disorders.

Number of Patients Treated

In 2013, Cedars-Sinai performed over 1800 inpatient spine procedures, more than all but one of the  hospitals listed among the USNews and World Report Top Hospitals for Orthopedics. 

Studies suggest that for many surgical procedures, hospitals that perform high volumes have better quality outcomes, i.e. lower short-term and long term mortality and morbidity. Volume is an indicator of experience, which influences outcomes in multiple ways. In addition to the experience of surgeons in performing specific procedures, high volume hospitals may institute specific care processes that improve outcomes and have the infrastructure dedicated to particular clinical specialties, including related technology and intensive care personnel. Commitment to quality standards throughout the institution is also an important determinant of better outcomes. 1,2  In addition, outcomes for high-risk procedures have been shown to be better when performed by more highly-trained surgeons than by general surgeons3.

Patient Care Processes and Outcomes

At the Cedars-Sinai Spine Center, a number of aspects of patient care are monitored for patients undergoing spinal procedures. These include:

  • The number of days the patient must remain in the hospital (length of stay)
  • The percentage of patients who spent days in the Intensive Care Unit (ICU)
  • The percentage of patients who were readmitted within 30 days
  • The mortality index, which compares the number of patient deaths to the number expected given the patient’s clinical conditions.  Any number below 1.0 is preferred, and the lower the index number, the better. 

Measures

 

Cedars-Sinai 2013

US News & World Report Top Orthopedic Hospitals for 2013

Average Length of Stay

4.03 days

4.55 days

Percentage of Patients Transferred to an ICU

7.96%

18.91%

30 Day Readmissions

1.03%

1.25%

Mortality Index

0.79

0.70

 

The data shown in the tables comes from the University HealthSystem Consortium (UHC), an is an alliance of 120 academic medical centers and 301 of their affiliated hospitals representing the nation's leading academic medical centers. The majority of these facilities participate in the Clinical DataBase/Resource Manager. participate in UHC's Clinical DataBase/Resource ManagerTM.  The data were assessed on April 14, 2014 and is based on patients discharged during 2013 and include patients with one of the following DRGs 28-30, 453-460, 471-473, 490, or 491.  The readmissions are based on related returns to the same hospital for patients discharged January thru October 2013.

 

Patient reported progress  at 3, 6, 12 and 24 month post-surgery is also measured.  The Oswestry Disability Index (ODI) is one of the principal condition-specific outcome measures used in the management of spinal disorders. The ODI is the most commonly utilized tool for outcome measure in patients with low back pain  It has been extensively tested, shown good psychometric properties, and is applicable in a wide variety of settings. The ODI gives a subjective percentage score for level of function (disability) in activities of daily living for those individuals rehabilitating from low back pain. Results from patients surveys are presented below. 

 

The Cedars-Sinai Spine Center also measures a patient’s level of pain at 3, 6, 12 and 24 months post-surgery. This survey asks patients to rate their pain along a continuum from “no pain” to “worst possible pain”. Scores were compared over time to assess the level of improvement. The results are presented below.

 


[1] Bach PB, Ann Intern Med 2009; 150:729-30
[2] Greene FL, Ann Surg Oncol 2007; 15:14-15
[3] Kozower BD et al, Ann Thorac Surg 2008; 86:1405-08



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