Hoag Memorial Hospital Presbyterian launched the Hoag Neurosurgery Spine
Program in February 2014. The multidisciplinary program aims to bring
specialists together for more efficient and effective care.
"The intent was to create a program not around a specialty, but around
the spine care service," says Burak Ozgur, MD, chief of service of
the Neurosurgery Spine Program at Hoag Neurosciences Institute. "We
wanted to create a program that identifies different elements of spine
care and triages the patient along the right pathway."
The program includes physical therapy, pain management and surgery. A
nurse navigator first works with the patients' diagnoses to triage
them for the best treatment. Many patients begin with conservative care;
however, for the select cases where surgery is indicated, patients are
placed on the fast track to see a surgeon.
"If we can treat the patient conservatively, that is the best option,"
says Dr. Ozgur. "But if they need surgery, we go through the spectrum
of whether it can be treated minimally invasively or through traditional
The care pathways are dictated by an evidence-based medicine approach
to care. The specialists meet on a monthly basis to discuss cases and
ensure the triage system is working appropriately. The system can be altered
and amended as time goes on.
"It's a dynamic process," says Michael Brant-Zawadzki, MD,
the executive medical director of the Neurosciences Institute at Hoag.
"It's an evolution. Our care pathways have embedded metrics for
process and outcomes measures so we get an assessment of the patient's
status upon entering into the care pathways as well as the long term health
and financial outcome of the process."
Analyzing outcomes and financial data will allow the Hoag physicians to
learn more about trends in readmissions, infections, re-operations and
emergency room visits. By tracking current data, they have already identified
new trends and are beginning to make changes for better quality of care.
"We found two key elements that are important and if we can identify
them early, we can be more prepared for our patients," says Dr. Ozgur.
"The first is having multiple comorbidities and the second is using
multiple pain medications or chronic pain medication use. As the patients
come in, the navigator can identify these factors and we can actually
put the surgery on hold until we optimize these elements. in the idea
is to fully optimize the patient's health and status prior to going
into surgery so they have better outcomes on the other end."
While the specialists aren't all under one roof yet, the program has
allowed them to work together and communicate more frequently. Their discussions
now focus on patient triaging and how their system will evolve.
"Unlike at Cleveland Clinic where the surgeons are all employed and
clinically integrated, an organization like ours still has physicians
who are at independent practices and we rely on virtual integration around
the care pathway and common metrics," says Dr. Brant-Zawadzki. "We
have a communication process facilitated by the modern digital age as
well as the nurse navigator."
The physicians are also paying close attention to cost of care, a main
theme in today's drive to reform healthcare spending. "As healthcare
costs and resources are limited, we need to provide better value,"
says Dr. Ozgur. "If we can prove our system works, then I can see
it multiplying and growing in scale to other services and hospitals."
The future of healthcare will be driven by the cost and quality initiatives
different systems develop to truly provide value to patients. The Affordable
Care Act provoked providers to look at new ideas and will be a big factor
in how programs develop in the future.
"I think clearly that despite the Affordable Care Act's claim
of being healthcare reform, its health cost reform that's paramount,"
says Dr. Brant-Zawadzki. "To really reform healthcare, you need physician
leadership. Through physician leadership of such care pathways, through
integrative methods, true healthcare transformation and reform can occur."