title: The spine service line: optimizing patient-centered spine care.
abstract: METHODS
  Literature review and expert opinion on the delivery of spine care.
  
  
  OBJECTIVE
  Our objective was to describe the goals of a spine service line and encourage the implementation of a systems-based approach to spine care. The benefits to patients and institutions are discussed.
  
  
  BACKGROUND
  Spine care delivery and its associated costs are rising rapidly. There exists tremendous variability in the rate at which it is delivered. With so many options for spine care, patients are subject to decisions of providers with disparate backgrounds and expertise. This leads to inefficiencies in diagnosis and delivery of care. All these factors lead to increased costs of care of uncertain benefit and increased burden to society.
  
  
  METHODS
  The literature on systems-based approaches to spine care was reviewed. Those relating to health care policy and recent clinical trials were emphasized. How these data work in a systems-based approach was described. Additionally, the authors' experiences working in and within a structured spine care system were related and included.
  
  
  RESULTS
  We describe 3 spine care episodes and where each possesses particular inefficiencies that lead to increased costs without added value to the delivery of spine care. The primary episode is the start of the patient's painful incident. We propose a more uniform guidelines-based approach using appropriate (and similar) diagnostic testing and education. The secondary phase of care can be costly as more sophisticated diagnostic and treatment methods are instituted. Within an institution or spine care practice, matching the level of providers with the patients at this phase of care would lead to better utilization of resources. Additionally, benefits to the institution would be greater if managed properly. The third phase of care focuses on intervention with long-term benefits. We discuss the use of registry like data and analysis of outcomes on these patients. Agreement within a group or institution on operative indications would allow for more uniform analysis of these outcomes. Alternative revenue streams are also discussed.
  
  
  CONCLUSIONS
  The patient with spinal disease is in need of high-quality, proven, and efficient care. Using a systems-based approach, we can minimize escalating costs associated with inefficient health care and delivery. Cooperation between physicians and institutions is critical to this process.
authors.affiliation: Boston Spine Group, New England Baptist Hospital, Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA 02120, USA. bkwon@nebh.org
authors.forename: Brian
authors.initials: B
authors.lastname: Kwon
authors.forename: Scott G
authors.initials: SG
authors.lastname: Tromanhauser
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Banco
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000379:methods / Q000592:standards; D006282:Health Personnel / Q000191:economics / Q000592:standards; D006801:Humans; D018802:Patient-Centered Care / Q000191:economics / Q000379:methods* / Q000592:standards*; D013122:Spinal Diseases / Q000628:therapy*