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Defining the Value of Spine Care
Jeffrey A Rihn, Alexander R Vaccaro, Todd J Albert
1:
Introduction: Understanding the Value of Spine Care
2:
Definition of Common Terminology
INTRODUCTION
BIAS
Selection Bias
Measurement Bias
Response Bias (or Non-response Bias)
CLINICAL PRACTICE GUIDELINE
COMPARATIVE EFFECTIVENESS RESEARCH
CONJOINT ANALYSIS
CONTINGENT VALUATION
COST
Cost and Healthcare Economics
Opportunity Cost
COST-BENEFIT ANALYSIS
COST-COMPARISON ANALYSIS
COST-CONSEQUENCE ANALYSIS
COST-EFFECTIVENESS ACCEPTABILITY CURVE
COST-EFFECTIVENESS ANALYSIS
COST-EFFECTIVENESS RATIO
COST MEASUREMENT
Human Capital Method
Friction Cost Method
COST-MINIMIZATION ANALYSIS
COST OF ILLNESS STUDY
COST-UTILITY ANALYSIS
COST TO CHARGE RATIO
DECISION ANALYSIS
DECISION TREE
DISABILITY-ADJUSTED LIFE YEAR
DISEASE-SPECIFIC MEASURES
DISCOUNTING
DOMINANCE
ECONOMIC ANALYSIS
Efficacy
Effectiveness
EuroQol (EQ-5D)
EVIDENCE-BASED MEDICINE
HEALTH-RELATED QUALITY OF LIFE
HEALTH UTILITIES INDEX
HEALTHY YEARS’ EQUIVALENT
INCIDENCE
INCREMENTAL COST-EFFECTIVENESS RATIO
LIKELIHOOD RATIO
MINIMAL CLINICAL IMPORTANT DIFFERENCE
NET BENEFIT
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
PATIENT-REPORTED OUTCOMES
NEGATIVE PREDICTIVE VALUE
POSITIVE PREDICTIVE VALUE
PREVALENCE
PROCESS MEASURE
QUALITY-ADJUSTED LIFE YEAR
QUALITY OF CARE
QUALITY OF WELL-BEING SCALE
RELIABILITY
RESPONSIVENESS
RISK
Attributable Risk
Relative Risk
RISK ADJUSTMENT
SENSITIVITY
SICKNESS IMPACT PROFILE
SOCIOECONOMIC STATUS
SPECIFICITY
UTILITY
UTILITY MEASUREMENT
Standard Gamble
Time Trade-off
VALIDITY
VALUE
3:
The Use of Process Measures in Measuring the Quality of Spine Care
INTRODUCTION
BACKGROUND
PROCESS MEASURES
Antibiotic Prophylaxis
Antibiotic Timing
Antibiotics Discontinued within Twenty-four Hours
Appropriate Hair Removal
Operative Duration
COMPLICATIONS
LIMITATIONS
CONCLUSIONS
4:
Disease-Specific Health-Related Quality of Life Measures: Lumbar Degenerative Disease
INTRODUCTION
OSWESTRY DISABILITY INDEX
ROLAND-MORRIS DISABILITY QUESTIONNAIRE
SYMPTOM-SPECIFIC MEASUREMENT TOOLS: SCIATICA AND SPINAL STENOSIS
CONCLUSION
5:
Disease-Specific Health-Related Quality of Life Measures: Cervical Degenerative Disease
INTRODUCTION
CERVICAL DEGENERATIVE DISk DISEASE AND RADICULOPATHY
Neck Disability Index
Patient-Specific Functional Scale
CERVICAL SPONDYLOTIC MYELOPATHY
Unidimensional Instruments
Multidimensional Instruments
Japanese Orthopaedic Association Score
Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire
CONCLUSION
6:
Disease-Specific Health-Related Quality of Life Measures: Spinal Deformity
INTRODUCTION
SCOLIOSIS RESEARCH SOCIETY-22R
Adolescent Idiopathic Scoliosis
Adult Spine Deformity
Responsiveness to Change
Spinal Appearance Questionnaire
Scoliosis Quality of Life Index in Adolescent Idiopathic Scoliosis
Quality of Life Profile for Spine Deformities
Early Onset Scoliosis Questionnaire
CONCLUSION
7:
General Measures of Health-Related Quality of Life: SF-36 and Related Measures
INTRODUCTION
BACKGROUND
DETAILED DESCRIPTION OF MEASUREMENT TOOL
Reliability, Validity and Responsiveness
Limitations
CONCLUSION
8:
Numerical Rating Scales
INTRODUCTION
VISUAL ANALOG SCALE
Practical Issues
NUMERICAL RATING SCALE
QUESTIONNAIRES AND VARIATIONS
Populations
Scale Formats
Instructions for Patients
How Many Scales?
Other Items
Electronic Administration
Minimal Clinically Important Difference
DISCUSSION
Future
9:
Health Status Preference, Utility, and Health-Related Quality of Life in the Assessment of Spinal Disorders and Other Medical Conditions
INTRODUCTION
DEFINITION OF UTILITY SCORE
Health Utilities Index
EuroQol-5D
Short Form-6D
Utility Scores and Value
Defining the Utility of Specific Medical Conditions
UTILITIES AND VALUE-BASED HEALTHCARE
Accountability for Value in Measuring Quality
CONCLUSION
10:
The Quality-Adjusted Life Year
INTRODUCTION
CALCULATION OF QUALITY-ADJUSTED LIFE YEARS
LIMITATIONS OF QUALITY-ADJUSTED LIFE YEARS
USE OF QUALITY-ADJUSTED LIFE YEARS
CONCLUSION
11:
How to Calculate the Cost of Spine Care
INTRODUCTION
DEFINING COST
Perspective
Direct Costs
Indirect Costs
METHODS OF COST DETERMINATION
Human Capital Approach
Cost Minimization Analysis
Opportunity Cost
CHALLENGES IN DETERMINING COSTS
Deriving a Specific Dollar Amount
Hospital Costs
Hospital Charges
Hospital Payments Received
Modeling
Patient Self-Report
Large Claims Databases
Other Factors to Consider
COMMENT ON COST AND QUALITY-ADJUSTED LIFE YEARS
DISCUSSION
12:
Decision Tree Analysis and Simulation Modeling in Spine Care
INTRODUCTION
Utility of Decision Analysis in Spine Care
Decision Model
Probabilities
Utilities
ANALYSIS: A DETERMINISTIC APPROACH
ANALYSIS: STOCHASTIC SIMULATION APPROACHES
ANALYSIS: MARKOV CHAIN APPROACHES
SENSITIVITY ANALYSIS
IMPLICATIONS FOR DECISION-MAKING IN SPINE CARE
13:
Cost Utility Analysis: Use of Average Cost Per Quality-Adjusted Life Year Versus the Incremental Cost- Effectiveness Ratio
INTRODUCTION
COST-EFFECTIVENESS RESEARCH
Cost Utility Analysis
Average Cost per Quality-Adjusted Life Year
Incremental Cost-Effectiveness Ratio
Advantages and Disadvantages
CONCLUSION
14:
Value-Based Evaluation of New Spine-Related Technology
INTRODUCTION OF NEW TECHNOLOGY
MEASURING VALUE
MEASURING COST
INCREMENTAL COST EFFECTIVENESS RATIO ANALYSIS WITH RESPECT TO NEW TECHNOLOGY
SUMMARY
15:
Determining Value with Outcome Measures: Perspectives from Each of the Stakeholders of Spine Care Delivery
INTRODUCTION
PATIENTS
PHYSICIANS
HOSPITALS
PAYERS
POLICY MAKERS
EMPLOYERS
16:
Developing Value-Based Guidelines for the Treatment of Spinal Disorders
INTRODUCTION
ISSUES WITH CURRENT GUIDELINES
Developing Value-Based Guidelines: Focus on Diagnostic Clarity and Consider Nonsurgical Options
CONCLUSION
17:
Comparative Effectiveness Research in Spine Care
INTRODUCTION
OVERVIEW OF COMPARATIVE EFFECTIVENESS RESEARCH
Definition: What is Comparative Effectiveness Research?
Types of Comparative Effectiveness Research
COMPARATIVE EFFECTIVENESS RESEARCH AND SPINE CARE
Trends in Healthcare Expenditures Related to Spine Care
Priority Areas of Comparative Effectiveness Research Related to Spine Care Identified by the Institute of Medicine
Implications of Comparative Effectiveness Research for Spine Care
Development of Predictive Care Paths
Changing Quality Metrics
CONCLUSION
18:
Comparative Effectiveness Research in Spine Care: SPORT as an Example
INTRODUCTION
ASSESSMENT OF HEALTH STATUS IN SPINE PATIENT OUTCOMES RESEARCH TRIAL
Determination of Cost
ASSESSMENT OF OUTCOMES IN SPINE PATIENT OUTCOMES RESEARCH TRIAL
Calculation of the Incremental Cost-Effectiveness Ratio in Spine Patient Outcomes Research Trial
Incremental Cost-Effectiveness Ratio for Spinal Stenosis with and without Spondylolisthesis
Incremental Cost-Effectiveness Ratio for Intervetebral Disc Herniation
Spine Patient Outcomes Research Trial–As an Example Going Forward
19:
Logistics: How to Get Started
INTRODUCTION
STEP 1: DEFINING THE STUDY AND COMPARISON INTERVENTIONS
STEP 2: DEFINING THE TARGET POPULATION
STEP 3: DEFINING THE TIME HORIZON
STEP 4: CREATING THE CONCEPTUAL MODEL
STEP 5: OBTAINING THE DATA
Obtaining Utility Data
Obtaining Cost Data
STEP 6: PERFORM THE ANALYSIS
STEP 7: USE THE INFORMATION
Appendices
CHAPTER 4 Disease-Specific Health-Related Quality of Life Measures: Lumbar Degenerative Disease
Appendix 4.1 The Roland-Morris Disability Questionnaire
Appendix 4.2 Sciatica Bothersomeness and Frequency Indices Questionnaire
Appendix 4.3 The Zurich Claudication Questionnaire
CHAPTER 5 Disease-Specific Health-Related Quality of Life Measures: Cervical Degenerative Disease
Appendix 5.1 Neck Disability Index
Appendix 5.2 Scoring Neck Disability Index
Appendix 5.3 Patient-Specific Functional Scale
Appendix 5.4 Nurick Scale
Appendix 5.5 Japanese Orthopaedic Association Score
Appendix 5.6 Chiles’ Modified Japanese Orthopaedic Association Score
Appendix 5.7 Benzel's Modified Japanese Orthopaedic Association Score
Appendix 5.8 Japanese Orthopaedic Association Score Assessment
Appendix 5.9 The Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ)
CHAPTER 6 Disease-Specific Health-Related Quality of Life Measures: Spinal Deformity
Appendix 6.1
Appendix 6.2
Appendix 6.3
CHAPTER 7 General Measures of Health-Related Quality of Life: SF-36 and Related Measures
Appendix 7.1 SF-36(tm) Health Survey
INDEX
TOC
Index
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