RESUMO
STUDY DESIGN: Cohort study. OBJECTIVE: The aim of this study was to determine the rate of accurate conflict of interest (COI) disclosure within three prominent subspecialty Spine journals during a 4-year period. SUMMARY OF BACKGROUND DATA: Industry-physician relationships are crucial for technological advancement in spine surgery but serve as a source of bias in biomedical research. The Open Payments Database (OPD) was established after 2010 to increase financial transparency. METHODS: All research articles published from 2014 to 2017 in Spine, The Spine Journal (TSJ), and the Journal of Neurosurgery: Spine (JNS) were reviewed in this study. In these articles, all author's COI statements were recorded. The OPD was queried for all author entries within the disclose period of the journal. Discrepancies between the author's self-reported COIs and the documented COIs from OPD were recorded. RESULTS: A total of 6816 articles meeting inclusion criteria between 2014 and 2017 in Spine, TSJ, and JNS with 39,869 contributing authors. Overall, 15.8% of all authors were found to have an OPD financial relationship. Of 2633 authors in Spine with financial disclosures, 77.1% had accurate financial disclosures; 42.5% and 41.0% of authors with financial relationships in the OPD had accurate financial disclosures in TSJ and JNS, respectively. The total value of undisclosed conflicts of interest between 2014 and 2017 was $421 million with $1.48 billion in accurate disclosures. Of undisclosed payments, 68.7% were <$1000 and only 7.2% were >$10,000. Undisclosed payments included $180 million in research funding and $188 million in royalties. CONCLUSION: This study demonstrates that undisclosed COI is highly prevalent for authors in major Spine journals. This study indicates that there remains a need to standardize definitions and financial thresholds for significant COI as well as to shift the reporting burden for COI to journals who actively review potential COIs instead of relying on self-reporting. LEVEL OF EVIDENCE: 3.
Assuntos
Conflito de Interesses , Revelação/normas , Publicações Periódicas como Assunto/normas , Médicos/normas , Doenças da Coluna Vertebral , Pesquisa Biomédica/economia , Pesquisa Biomédica/normas , Estudos de Coortes , Conflito de Interesses/economia , Bases de Dados Factuais/normas , Humanos , Publicações Periódicas como Assunto/economia , Médicos/economia , Autorrelato/economia , Autorrelato/normas , Doenças da Coluna Vertebral/economia , Doenças da Coluna Vertebral/cirurgiaRESUMO
Many of the studies in the spine surgical literature using national databases have been directed at examining adverse events, readmission rates, cost, and risk factors for poorer outcomes. Although such studies allow for assessment of large cohorts taken from multiple institutions, they are limited by data collection methods, short-term follow-up, and minimal assessment of functional outcomes. Furthermore, few studies are directed at producing actionable practice changes to improve patient care. Recent work aimed at producing databases with more relevance to spine surgery represent exciting developments to the rapidly growing field of health outcomes research.
Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Readmissão do Paciente , Complicações Pós-Operatórias/etiologia , Doenças da Coluna Vertebral/cirurgia , Bases de Dados Factuais/estatística & dados numéricos , Humanos , Readmissão do Paciente/economia , Fatores de Risco , Doenças da Coluna Vertebral/economiaRESUMO
As reimbursement transitions from a volume-based to a value-based system, innovation in health care delivery will be needed. The process of innovation begins with framing the problem that needs to be solved along with the strategic vision that has to be achieved. Similar to scientific testing, a hypothesis is generated for a new solution to a problem. Innovation requires conducting a disciplined form of experimentation and then learning from the process. This manuscript will discuss the different types of innovation, and the key steps necessary for successful innovation in the health care field.
Assuntos
Atenção à Saúde , Ortopedia/tendências , Doenças da Coluna Vertebral/economia , Controle de Custos , Humanos , Inovação Organizacional , Mecanismo de Reembolso , Doenças da Coluna Vertebral/cirurgia , Estados UnidosRESUMO
INTRODUCTION: The state of value-based management of spinal disorders and ongoing Brazilian strategies toward its implementation are highlighted in this article. METHODS: The health care system, economic impact of spine surgery, use of patient-reported outcomes, ongoing studies about health economics, and current strategies toward implementation of quality assessment of spine care in Brazil are reviewed. RESULTS: During the past 20 years, there has been an increase of 226% in the number and 540% in the total cost of spine surgeries in the public health system. Examples of economic regulatory mechanisms involve the process of health technology assessment and the auditing processes imposed by health insurance companies. Some barriers to implementing clinical registries were identified from a large Latin American survey. Strategies based on education and technical support have been conducted to improve the quality of comparative-effectiveness research in spine care. Only 1 cost-utility study on spine care has been published until now. CONCLUSIONS: The paradigm of value-based management of spinal disorders is still incipient in Brazil. Some issues from our analysis must be emphasized: (1) Brazil presents many regional disparities and scarce resources for health care; it is crucial for the health system to allocate resources based on the value of interventions; (2) because of the high economic and social burden of developing new technologies for diagnosis and treatment, research in health economics of spine care in Brazil should be prioritized; (3) these efforts would help to provide a more accessible and effective health system for patients with spinal problems.
Assuntos
Gerenciamento Clínico , Doenças da Coluna Vertebral/economia , Doenças da Coluna Vertebral/terapia , Adulto , Idoso , Brasil , Pesquisa Comparativa da Efetividade , Efeitos Psicossociais da Doença , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neurocirurgia/economia , Neurocirurgia/tendências , Garantia da Qualidade dos Cuidados de Saúde , Sistema de Registros , Alocação de Recursos , Doenças da Coluna Vertebral/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the estimated cost of treatment of spinal disorders to those of this treatment in a specialized center. METHODS: An evaluation of average treatment costs of 399 patients referred by a Health Insurance Company for evaluation and treatment at the Spine Treatment Reference Center of Hospital Israelita Albert Einstein. All patients presented with an indication for surgical treatment before being referred for assessment. Of the total number of patients referred, only 54 underwent surgical treatment and 112 received a conservative treatment with motor physical therapy and acupuncture. The costs of both treatments were calculated based on a previously agreed table of values for reimbursement for each phase of treatment. RESULTS: Patients treated non-surgically had an average treatment cost of US$ 1,650.00, while patients treated surgically had an average cost of US$ 18,520.00. The total estimated cost of the cohort of patients treated was US$ 1,184,810.00, which represents a 158.5% decrease relative to the total cost projected for these same patients if the initial type of treatment indicated were performed. CONCLUSION: Treatment carried out within a center specialized in treating spine pathologies has global costs lower than those regularly observed.
Assuntos
Redução de Custos , Custos de Cuidados de Saúde , Hospitais Especializados/economia , Doenças da Coluna Vertebral/cirurgia , Brasil , Análise Custo-Benefício/economia , Feminino , Humanos , Masculino , Doenças da Coluna Vertebral/economia , Resultado do TratamentoRESUMO
BACKGROUND: High prevalence and high costs in the treatment of spine injuries make a cost study necessary. The objective of this paper is to analyze, from the economic point of view, the behavior of traumatic and non-traumatic spinal pathologies in relation to hospital stay. METHODS: Analysis of economic cost per hospital stay (January 2000 to May 2010). RESULTS: 4,173 cases studied, 45% women and 55% men, predominantly elderly and a mean age of 48.9, standard deviation 16.8 years, with a notable increase in hospital expenses in prevalence and peak months: January, February and April; and a decrease in July, October and December. Total expenses for hospital stay were estimated as $85,565,288.00. Traumatic entities consumed $40,404,477.00, and degenerative $21,866,815.00. The months of highest spending were: April, $11,072,683.00, December, $8,423,773.00 and February $8,154,152.00; whereas July showed the lowest spending: $4,874,261.00. Inflation up to July 2011 remained at 3.55% on average, down 2.98 percentage points from 2008 figures. DISCUSSION: there is a clear increase in spending connected with spine condition treatment at hospitals, in particular those resulting from traumatic events. The definition of risk groups for preventive measures is also reflected in the spending records. Spending on hospital treatment of spinal conditions of the elderly reflects an increment in degenerative conditions. CONCLUSION: It is necessary to plan a timely resource distribution by month and year in order to achieve a better and more efficient scheme for health services. The epidemiological basis for the reorientation of the current models is now clear.