Spine SCOAP

[101N]

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Members don't see this ad.

This looks pretty interesting...
http://www.painsociety.com/conference/spine/SCOAP.php

9:00-11:00 am Friday
Spine SCOAP: Pre-conference Workshop
Washington State Spine Forum

Safety, quality, cost, and even use patterns of resource-intensive healthcare interventions like spine surgery need to be continually monitored and improved. The Surgical Care and Outcomes Assessment Program (SCOAP) was developed by doctors in 2006 to start addressing these issues. SCOAP monitors the performance and outcomes of surgery, gives doctors reports of their performance, and changes practice through initiatives like the SCOAP surgical checklist. Supported by the state’s Life Science Development Fund, SCOAP is deployed at nearly all hospitals in Washington State and across 7 clinical areas. In 2011, SCOAP added the Spine SCOAP registry to collect data for spine procedures, an initiative that is now in place in 17 Washington State hospitals with over 3000 cases in the registry.

SCOAP was just the start. Since new techniques and drugs are always emerging, SCOAP hospitals came together to discover what works best in a research platform called CERTAIN (Comparative Effectiveness Research Translational Network). Research findings from CERTAIN are translated back to improved patient care through SCOAP and help make Washington a safer place to have surgery.

A key component to the success of SCOAP and CERTAIN is a broad collaborative of doctors, patients, insurers and policy makers that support the work. The Washington State Spine Forum is the arena for those stakeholders to come together and use the information coming from SCOAP and CERTAIN to improve spine care across the state. Addressing variability in safety, quality, and use of resource-intensive spine care is the focus of this unique collaborative. All interested parties are invited to participate.

The Washington State Spine Forum addresses the disturbing variability in the safety, quality, and use of resource-intensive spine care and creates a safe arena for stakeholders to share and hear varied perspectives on the safety, quality and appropriate use of spine interventions. It also provides valuable feedback around research activities to ensure appropriate and meaningful prioritization of research questions and other activities so that evidence and research results are of maximum value, benefit, and use to physicians, patients, payers, and other relevant healthcare stakeholders.

For more information, go to www.becertain.org

Washington State Spine Forum http://www.becertain.org/researchers/spine/spine_care_forum
SCOAP http://www.becertain.org/researchers/spine/spine_scoap
CERTAIN http://www.becertain.org/researchers/spine/spine_research



http://www.becertain.org/hospitals/spine

 

[Aether2000]

Eventually Washington State will become the safest place in the union to avoid side effects or death from medication or complications/death from procedures/surgeries. Medications, injections, neuroablation, neuromodulation, and spine surgery will or are being outlawed and therefore the safety will be 100% compared to the rest of the US. It will be a great place to live as long as a person is healthy.

 

[Ducttape]

Eventually Washington State will become the safest place in the union to avoid side effects or death from medication or complications/death from procedures/surgeries. Medications, injections, neuroablation, neuromodulation, and spine surgery will or are being outlawed and therefore the safety will be 100% compared to the rest of the US. It will be a great place to live as long as a person is healthy.

and doesn't have back pain..,

 

[101N]

This talk was the highlight of the meeting. If you work in a multidisciplinary spine practice you owe it to your patients to look into WA state's Spine SCOAP. This is a real effort at improving spine surgical care and providing transparency all along the way.

Here is a background PP

http://www.google.com/url?sa=t&rct=...=ubWBjp0IYmNL9l6anvCr3A&bvm=bv.43287494,d.aWM

 

[Ducttape]

This talk was the highlight of the meeting. If you work in a multidisciplinary spine practice you owe it to your patients to look into WA state's Spine SCOAP. This is a real effort at improving spine surgical care and providing transparancy all along the way.

Here is a background PP

http://www.google.com/url?sa=t&rct=...=ubWBjp0IYmNL9l6anvCr3A&bvm=bv.43287494,d.aWM

the issue is when do you stop, and who do you believe. Reviewing all that you have posted, the conclusion that I come to is that we as society will end up deciding who to operate on based entirely on socioeconomic status. the Poor, WC patients, will be denied surgery. The Rich will be allowed to continue to have surgery.

organizations with significant financial interest should not be allowed to participate in the discussion - be it an organization of neurosurgeons out to protect their field and economic gains, or a Workmens Comp carrier whose primary concern is to save money and get injured workers back to work.

 

[101N]

and who do you believe.

With respect to the Spine SCOAP all of the data they collect - and reported- has been shown to be relavent fusion outcome: smoking status, BMI, nutritional status (albumin), opioid use, and payor. They also collect and report pre and post NDI/ODI, RTW, NRS, infection rate, and reoperations. This surveillance system is becoming standard of care in WA state and it informs all stake holders - patients, payors, providers - on the efficacy and safety of spinal fusions. If big data shows that 2ppd smokers, with a BMI of 40, DM and HbA1C of 11, albumin of 2, and open comp claim are poor surgical candidates so be it. Maybe that combination of risk factors SHOULD lead to a postponement of fusion and, instead, enrollment in a multidisciplinary pain rehab program that now CAN be funded because all those useless 80K fusions in similar patients are being avoided.

This system - or variations on it - will be standard of care. Who doesn't want transparency and outcome reporting.

 

[Aether2000]

It all comes down to how best to evaluate what a person is worth. The Canadians discovered this decades ago.....those with a less likely successful outcome no matter whether it is their fault or not, will be denied medical care. These unfortuates are deemed unworthy of medical care and the chance of having a less painful existence. It will indeed become the standard of care. It is the only possible solution.

 

[Ligament]

I would not trust anything Gary Franklin's name is associated with. Because of him, SCS is denied to all WA state injured workers for any diagnosis, including CRPS. Why not approved for CRPS? Because it does not work for a axial back pain per his biased review. In addition, he almost eliminated MB RFA out of his ignorance. Ive seen many destroyed patients with tryly end stage CRPS due to his leadership. Dont even see end stage crps in university clinics anymore....but in the workers comp system, sure do!!!

 

[101N]

I would not trust anything Gary Franklin's name is associated with. Because of him, SCS is denied to all WA state injured workers for any diagnosis, including CRPS. Why not approved for CRPS? Because it does not work for a axial back pain per his biased review. In addition, he almost eliminated MB RFA out of his ignorance. Ive seen many destroyed patients with tryly end stage CRPS due to his leadership. Dont even see end stage crps in university clinics anymore....but in the workers comp system, sure do!!!

You are blaming Gary Franklin for our poor outcomes? Stim, like fusion, doesn't appear to improve functional outcomes in comp patients.

Pain. 2010 Jan;148(1):14-25. doi: 10.1016/j.pain.2009.08.014. Epub 2009 Oct 28.
Spinal cord stimulation for failed back surgery syndrome: outcomes in a workers' compensation setting.
Turner JA, Hollingworth W, Comstock BA, Deyo RA.
Source
Department of Psychiatry & Behavioral Sciences and Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St., Room BB1517a, Box 356560, Seattle, WA 98195-6560, USA. [email protected]
Abstract
Questions remain concerning effectiveness and risks of spinal cord stimulation (SCS) for chronic back and leg pain after spine surgery ("failed back surgery syndrome" [FBSS]). This prospective, population-based controlled cohort study evaluated outcomes of workers' compensation recipients with FBSS who received at least a trial of SCS (SCS group, n=51) versus those who (1) were evaluated at a multidisciplinary pain clinic and did not receive SCS (Pain Clinic, n=39) or (2) received neither SCS nor pain clinic evaluation (Usual Care, n=68). Patients completed measures of pain, function, medication use, and work status at baseline and 6, 12, and 24 months later. We also examined work time loss compensation over 24 months. Few (<10%) patients in any group achieved success at any follow-up on the composite primary outcome encompassing less than daily opioid use and improvement in leg pain and function. At 6 months, the SCS group showed modestly greater improvement in leg pain and function, but with higher rates of daily opioid use. These differences disappeared by 12 months. Patients who received a permanent spinal cord stimulator did not differ from patients who received some pain clinic treatment on the primary outcome at any follow-up (<10% successful in each group at each follow-up) and 19% had them removed within 18 months. Both trial and permanent SCS were associated with adverse events. In sum, we found no evidence for greater effectiveness of SCS versus alternative treatments in this patient population after 6 months.
Copyright 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

 

[Ducttape]

dont get me wrong, i am all in favor for more and more evidence based information.

however, i am not in favor of organizations with an economic interest at stake in determining what is correct or incorrect treatment.

an analogy might be, say, a drug company helping determine policy by producing research, and paying physicians to encourage particular drug treatment.

Pain. 2010 Jan;148(1):14-25. doi: 10.1016/j.pain.2009.08.014. Epub 2009 Oct 28.
Spinal cord stimulation for failed back surgery syndrome: outcomes in a workers' compensation setting.
Turner JA, Hollingworth W, Comstock BA, Deyo RA.

in this particular subset of patient, what has been shown to be helpful? studies such as this one have the purpose of denying service, but the alternative of "usual care" has not shown to be beneficial. most government agencies, my suspect, will ultimately decide that NO care is best for WC failed back surgery patients - no SCS, no ESI, no meds, no PT, no neuromodulators.

dont doubt this has not already happened in another state across the country....

 

[lobelsteve]

Pain. 2010 Jan;148(1):14-25. doi: 10.1016/j.pain.2009.08.014. Epub 2009 Oct 28.
Spinal cord stimulation for failed back surgery syndrome: outcomes in a workers' compensation setting.
Turner JA, Hollingworth W, Comstock BA, Deyo RA.


ASA does not help MI.
Insulin does not help DM.
ABX do not fight infections.
Nothing helps pain.

 

[Ligament]

You are blaming Gary Franklin for our poor outcomes? Stim, like fusion, doesn't appear to improve functional outcomes in comp patients.

Pain. 2010 Jan;148(1):14-25. doi: 10.1016/j.pain.2009.08.014. Epub 2009 Oct 28.
Spinal cord stimulation for failed back surgery syndrome: outcomes in a workers' compensation setting.
Turner JA, Hollingworth W, Comstock BA, Deyo RA.
Source
Department of Psychiatry & Behavioral Sciences and Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St., Room BB1517a, Box 356560, Seattle, WA 98195-6560, USA. [email protected]
Abstract
Questions remain concerning effectiveness and risks of spinal cord stimulation (SCS) for chronic back and leg pain after spine surgery ("failed back surgery syndrome" [FBSS]). This prospective, population-based controlled cohort study evaluated outcomes of workers' compensation recipients with FBSS who received at least a trial of SCS (SCS group, n=51) versus those who (1) were evaluated at a multidisciplinary pain clinic and did not receive SCS (Pain Clinic, n=39) or (2) received neither SCS nor pain clinic evaluation (Usual Care, n=68). Patients completed measures of pain, function, medication use, and work status at baseline and 6, 12, and 24 months later. We also examined work time loss compensation over 24 months. Few (<10%) patients in any group achieved success at any follow-up on the composite primary outcome encompassing less than daily opioid use and improvement in leg pain and function. At 6 months, the SCS group showed modestly greater improvement in leg pain and function, but with higher rates of daily opioid use. These differences disappeared by 12 months. Patients who received a permanent spinal cord stimulator did not differ from patients who received some pain clinic treatment on the primary outcome at any follow-up (<10% successful in each group at each follow-up) and 19% had them removed within 18 months. Both trial and permanent SCS were associated with adverse events. In sum, we found no evidence for greater effectiveness of SCS versus alternative treatments in this patient population after 6 months.
Copyright 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Dude, fulminant CRPS patients are denied stims in Washington State workers comp...anybody that has treated CRPS knows stims are a godsend...

I don't care about SCS for axial back pain. I do care about SCS for CRPS and intractable neuropathic pain, such as say from folks getting their brachial plexus ripped out from a harvesting machine etc....