SpineCare Delivers Real Results
Dennis Maiman, MD, PhDMedical College of Wisconsin Neurosurgeon;
Medical Director, SpineCare Program
SpineCare is a Froedtert & Medical College of Wisconsin outpatient program that provides individualized, holistic care for people with acute spine disorders caused by injury or illness. By fostering patients' independence and involvement in their treatment plans, SpineCare encourages an early, safe return to routine activities and lessens the possibility of chronic spine problems. Dennis Maiman, MD, PhD, explains how the SpineCare approach achieves proven results in helping people manage back problems.
Q. What is the SpineCare program concept? Is it unique?The SpineCare Program concept is based on data that indicate transdisciplinary programs are the most effective. Not only do we have all of the disciplines in the same place, but the care that is provide is integrated. Our program includes neurosurgeons, physical medicine and rehabilitation specialists, neurologists, chiropractic physicians, nurses and physical and occupational therapists who work together as a team to coordinate tailored plans to meet each patient's individual needs. That's unique.
We're also unique in that we have a very strong focus on pathway-based care: everything we do is evidence based. Whether it is care provided by a therapist, nurse, physician or even a surgeon, there has to be proof that what we do works — there has to be sound, high-quality scientific literature to substantiate our efforts.
What also makes us unique is our strong focus on patient self-management. It is our goal to get patients to not treat spine problems as short-term events but to recognize that they have to be managed on an on-going basis, basically forever.
Q. Does the SpineCare approach make a difference in terms of outcome? How do you know?By following evidence-based procedures, we already know that what we do works. And that makes a huge difference to what happens to patients, in large part because they don't waste time wondering if what they're doing will help them.
We also track our own numbers and compare them to statistics compiled by workman's compensation and other spine databases. We have considerable evidence that our patients have a return-to-work rate that is double of that found in more traditional spine care settings. In fact, a recent evaluation of the SpineCare program found that 97 percent of our patients had returned to their work duties, with only minimal modifications to job requirements, within six months of their injury.
Additionally, the rate at which we perform surgery is half compared to other settings. Less than 5 percent of our patients undergo surgery and that's very low considering the population we treat. In the community at large, the surgical rate for spine problems is 12 percent. The reason our rate is so low, is that people in the SpineCare program get better without surgery. That's important, because surgery carries risks and it is not the answer for most back problems. We only operate on patients who are most likely to get better because of it, and only after they have gone through a quality rehabilitation program because that improves our surgical outcomes, as well.
Q. What is self-management and how does it help people with back problems?We teach people to take care of their own backs through ergonomic training and an aggressive physical exercise and strengthening program. For many people, it becomes a lifestyle change. You would be amazed at how many of our patients become different people. They get into exercise; they loose weight and do all sorts of things to help their backs because we provide the motivating factor.
Q. Do patients need to be referred to the SpineCare program?In many instances, patients are referred to our program by their primary physicians or surgeons, and when they are, these doctors are invited to become part of our team. Patients may also self refer. Before patients enter the program, they go through a triage evaluation — usually by phone — to make sure they’re appropriate for the program. Sometimes people are referred to us because of back pain, but their pain is actually caused by something else, such as a hip problem or chronic pain condition. But no matter what the situation, we believe we have an obligation to our referring doctors and patients to help them find the right care to meet their needs.
Author: Dennis Maiman, MD, PhD
Source: Every Day
Date: May - August 2005