Hawkins Foundation, Greenville, SC, USA.
Steadman Hawkins Clinic of the Carolinas, Prisma Health Upstate, Greenville, SC, USA.
J Shoulder Elbow Surg. 2024 Jun;33(6):1397-1403. doi: 10.1016/j.jse.2023.12.001. Epub 2024 Feb 1.
BACKGROUND: Implementation of a system anchored in patient outcomes is challenged to gain widespread adoption required to demonstrate the value of care provided for shoulder conditions. This is in large part because of the administrative burden created by current tools and clinical implementation barriers that limit practical use and therefore leave most clinicians, administrators, payers, and patients without a measure of what matters most: Are patients improving? Thus, we must ask ourselves, How do we accurately and efficiently measure and report quality of care in a simple, reliable, and easily communicated manner? We propose that the Single Assessment Numeric Evaluation (SANE) score is the best solution to measure patient improvement and can be used universally for all shoulder conditions. The measure is simple, valid, reliable, and sensitive to change and has the lowest implementation barrier compared with all other outcome measures. METHODS: We synthesized the available literature (11 studies) that demonstrates strong psychometrics comparable to legacy measures across >4000 patients with a wide range of shoulder conditions. RESULTS: SANE scores range from 40% to 60% at baseline for most patients before treatment and range from 75% to 85% at 1 year after therapy depending on the condition, similar to legacy scores such as the American Shoulder and Elbow Surgeons score. Additionally, the SANE score shows similar baseline and post-care measures across conditions that can be used to guide clinical care. This finding shows that the observed baseline and improvement scores can provide valuable patient assessment and can be used in aggregate for quality improvement and other value-based purposes. CONCLUSION: We strongly recommend the SANE score as the primary patient outcome measure for patients with all shoulder conditions, given the value of measuring every patient's progress and growing pressure to quantify patient outcomes.
背景:以患者结果为基础的系统实施受到广泛采用的挑战,难以证明所提供的肩部疾病护理的价值。这在很大程度上是因为当前工具和临床实施障碍所带来的行政负担,限制了实际应用,因此大多数临床医生、管理人员、支付者和患者都无法衡量最重要的指标:患者是否有所改善?因此,我们必须问自己,我们如何以简单、可靠和易于沟通的方式准确、有效地衡量和报告护理质量?我们提出,单一评估数字评估(SANE)评分是衡量患者改善的最佳解决方案,并且可以普遍用于所有肩部疾病。该测量方法简单、有效、可靠且对变化敏感,与所有其他结果测量方法相比,实施障碍最低。
方法:我们综合了现有的文献(11 项研究),这些研究证明了 SANE 评分在具有广泛肩部疾病的>4000 名患者中具有与传统测量方法相当的强大心理测量学特性。
结果:大多数患者在治疗前的基线 SANE 评分为 40%-60%,在治疗后 1 年的评分范围为 75%-85%,具体取决于疾病,与美国肩肘外科医生评分等传统评分相似。此外,SANE 评分在不同疾病之间显示出相似的基线和治疗后测量值,可以用于指导临床护理。这一发现表明,观察到的基线和改善评分可以为患者评估提供有价值的信息,并可以汇总用于质量改进和其他基于价值的目的。
结论:鉴于衡量每个患者进展的价值以及量化患者结果的压力越来越大,我们强烈建议将 SANE 评分作为所有肩部疾病患者的主要患者结果衡量标准。
Am J Sports Med. 2018-11-12