Resnick Daniel K, Tosteson Anna N A, Groman Rachel F, Ghogawala Zoher
*Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, K4/834 Clinical Science Center, Madison, WI †Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH ‡Clinical Affairs and Quality Improvement, Hart Health Strategies, Washington, DC §Department of Neurosurgery, Tufts University School of Medicine, Boston, MA; and ¶Lahey Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA.
Spine (Phila Pa 1976). 2014 Oct 15;39(22 Suppl 1):S43-50. doi: 10.1097/BRS.0000000000000581.
Topic review.
Describe value measurement in spine care and discuss the motivation for, methods for, and limitations of such measurement.
Spinal disorders are common and are an important cause of pain and disability. Numerous complementary and competing treatment strategies are used to treat spinal disorders, and the costs of these treatments is substantial and continue to rise despite clear evidence of improved health status as a result of these expenditures.
The authors present the economic and legislative imperatives forcing the assessment of value in spine care. The definition of value in health care and methods to measure value specifically in spine care are presented. Limitations to the utility of value judgments and caveats to their use are presented.
Examples of value calculations in spine care are presented and critiqued. Methods to improve and broaden the measurement of value across spine care are suggested, and the role of prospective registries in measuring value is discussed.
Value can be measured in spine care through the use of appropriate economic measures and patient-reported outcomes measures. Value must be interpreted in light of the perspective of the assessor, the duration of the assessment period, the degree of appropriate risk stratification, and the relative value of treatment alternatives.
专题综述。
描述脊柱护理中的价值评估，并讨论此类评估的动机、方法及局限性。
脊柱疾病很常见，是疼痛和残疾的重要原因。有许多互补且相互竞争的治疗策略用于治疗脊柱疾病，这些治疗的成本很高，而且尽管有明确证据表明这些支出能改善健康状况，但成本仍在持续上升。
作者阐述了促使脊柱护理价值评估的经济和立法要求。介绍了医疗保健中价值的定义以及专门用于脊柱护理价值评估的方法。还介绍了价值判断效用的局限性及其使用的注意事项。
给出并分析了脊柱护理中价值计算的示例。提出了改进和拓宽脊柱护理价值评估的方法，并讨论了前瞻性登记在价值评估中的作用。
通过使用适当的经济指标和患者报告的结局指标，可以在脊柱护理中评估价值。必须根据评估者的角度、评估期的时长、适当的风险分层程度以及治疗替代方案的相对价值来解读价值。
