At the 2024 DNV Healthcare Symposium, HonorHealth and CODE Technology shared an advanced look at how the targeted use of patient-reported outcome (PRO) data is increasing the quality outcomes for spine surgery. By utilizing validated patient-reported outcome measures (PROMs) such as the Oswestry Disability Index (ODI) and the Neck Disability Index (NDI), HonorHealth is setting a patient-inclusive standard for recovery assessment and care refinement in spine procedures.
This collaboration showed how PROMs data can serve as a foundation for quality improvement and a strategic resource in healthcare—bridging the gap between patient-reported experiences and the measurable outcomes that healthcare quality professionals rely on to drive continuous improvement.
ODI and NDI: Foundational Metrics in Spine Surgery
In the world of spine surgery, the Oswestry Disability Index (ODI) and the Neck Disability Index (NDI) are important tools for assessing patient outcomes. These validated measures provide insight into the functional and pain-related challenges facing patients with lumbar and cervical spine conditions. Higher ODI and NDI scores reflect greater levels of disability, while lower scores indicate higher functionality and reduced pain.
Since 2016, CODE Technology has collaborated with HonorHealth across multiple service lines to collect, report and utilize patient-reported outcomes. This specific proof of concept effort, focused on investigating how PROMs could be used to understand spine surgery outcomes with the plan to apply the knowledge gained across service lines. The results were presented at the 2024 DNV Healthcare Symposium.
With the scope of this collaboration on PROMs and spine surgery, HonorHealth utilized ODI/NDI scores pre-operatively and post-operatively to evaluate the benefit of surgical interventions. This investigation established preliminary functional improvement thresholds and post-operative PROM target scores as promising markers for successful recovery. These proof-of-concept findings hold strong potential for scaling across the organization, providing a foundation that could be seamlessly embedded into quality and performance improvement efforts.
Defining Functional Improvement: What Success Looks Like for Patients
Functional improvement, in the context of this data deep-dive, refers to the difference in a patient’s pre-operative to 1-year post-operative ODI/NDI scores– quantifying a patient’s improvement in performing daily activities comfortably and independently post-surgery. By exploring the validity of functional improvement benchmarks for ODI and NDI scores, HonorHealth could enable their teams to more accurately assess whether surgical outcomes align with patients’ recovery goals and expectations. These insights offer promising groundwork, suggesting how such benchmarks could connect PROM scores to patient expectations on a broader scale. Natural next question: how could HonorHealth connect PROM scores to patient expectations?
Linking PROM Scores and Functional Improvement Benchmarks to Patient Satisfaction
Understanding the link between PROM scores, functional improvement and patient satisfaction is essential in assessing the true impact of surgical care: PROM scores are rich points of data, but the improvement of PROM scores over time can serve as an even more insightful quality metric.
To directly connect functional improvement to patient satisfaction, we have to layer in another data set: a quantitative understanding of how the patient views the surgical experience. A key component of this approach involves using a five-point Likert scale question on patient experience: “The results of the surgery have met my expectations.” By combining functional improvement data with patient feedback, HonorHealth provides a richer view of whether surgeries deliver on patients’ expectations of recovery and quality of life.
The Analysis
To deepen this understanding, CODE Technology posed a pivotal research question: Is there an ODI and NDI score that correlates with how the patient reported that the surgery met their expectations 1-year post-operatively? The intent of this question was to identify specific functional improvement scores that align with patient-reported satisfaction, offering valuable insights into quality measurement.
To perform this analysis (a sample of 2,804 lumbar patients and 1,900 cervical patients ), CODE Technology collected each patient’s 1-year ODI or NDI score, tracked the change (or “delta”) from their pre-operative score, and cross-referenced these data points with responses to the five-point Likert scale on patient experience. Outcomes were then categorized based on patients’ responses to the experience question: those who responded “agree” or “strongly agree” were classified as having outcomes that met their expectations, while those who chose “neutral,” “disagree,” or “strongly disagree” were categorized as not meeting their expectations.
This stratification provided a clear framework for distinguishing which functional improvement deltas correlated with higher satisfaction and a successful patient experience. By graphing these responses on scatter plots and applying trendline analysis, CODE Technology and HonorHealth uncovered patterns that revealed a relationship between specific ODI/NDI improvement thresholds and patient satisfaction.
Quantifying Success:
Functional Improvement
Within HonorHealth’s data, we identified specific improvement thresholds that served as reliable quality markers: a 21-point improvement in the ODI score for lumbar spine surgeries and a 17-point improvement in the NDI score for cervical spine surgeries. These benchmarks could allow clinical teams to measure functional recovery in a way that aligns with patient expectations, ensuring that surgical outcomes support both clinical objectives and patient-defined success.
This approach also aligns with CMS’ emphasis on substantial clinical benefit (SCB) thresholds within programs like IQR, OQR, and TEAM. By aiming to link functional improvement thresholds with patient-reported satisfaction, HonorHealth envisions quality initiatives that not only demonstrate clinical effectiveness but also elevate the patient-centered experience.
Post-operative Target Scores
In addition to setting thresholds for functional improvement, CODE Technology and HonorHealth saw in the data that specific post-operative PROM score goals contributed to maximizing the value of spine surgeries. For lumbar procedures, a 1-year post-operative ODI target score of 23 serves as a benchmark for successful recovery, while cervical spine surgeries aim for a post-operative NDI score of 26. These scores are not just data points—they embody recovery goals that reflect patient-reported satisfaction, setting a standard for gauging surgical success.
Establishing these benchmarks enables HonorHealth’s quality teams to assess recovery outcomes on both individual and aggregate levels. With this structured approach, quality professionals can more effectively verify that surgical practices align with patient recovery goals, making it easier to identify opportunities for immediate improvement and long-term refinement in care.
Improving Post-operative Care through Targeted Nurse Navigator Support
HonorHealth plans to expand its use of PROM data beyond outcome measurement by leveraging these insights to make strategic resource assignments. Specifically, by analyzing pre-operative ODI, NDI, and PROMIS mental health scores, they hope to proactively identify higher-need patients and assign nurse navigator support to those who may face additional recovery challenges.
For those high-need patients, nurse navigators play a vital role in managing care and guiding patients through recovery, helping to minimize complications and enhance the overall patient experience. For quality professionals, this proactive strategy exemplifies how patient-reported data can reveal which resources are most needed and where interventions will have the highest impact—allowing for a more focused allocation of clinical staff that ultimately elevates care standards.
Refining Surgical Practices Using PROM-Driven Insights
PROM data at HonorHealth could continue to be instrumental in refining surgical practices; the analysis of ODI and NDI outcomes helps to identify surgical techniques that lead to the best functional improvements and minimize complications.
Drilling down to individual surgeon outcomes enables organization-specific benchmarking and clearly reveals high-performing surgeons. By examining practices that minimize complications, such as unplanned visits or additional surgeries, HonorHealth can consider strategies that enhance recovery and patient satisfaction.
This potential for in-depth analysis fosters continuous quality improvement and can enhance transparency within the clinical team. By examining PROMs alongside individual surgeon data, HonorHealth gains a comprehensive understanding of which surgical practices yield the best patient outcomes; providing actionable insights that help refine surgical techniques and ensure alignment with DNV standards and quality goals.
HonorHealth | A Beacon Of PRO-Driven Decision-Making
The use of PROs in spine surgery at HonorHealth exemplifies a transformative shift toward patient-centered care, enhancing both clinical effectiveness and satisfaction. By integrating insights from the ODI and NDI with operational data, HonorHealth is establishing a comprehensive framework that prioritizes patient experience and satisfaction. This strategic approach empowers clinical teams to refine surgical practices, optimize resource allocation, and ultimately elevate the standard of care.
As HonorHealth continues to leverage PRO data, it is not just measuring success through clinical metrics but also through the lens of patient expectations and experiences. This commitment to continuous improvement ensures that every patient’s journey is valued, and every outcome is optimized, reinforcing HonorHealth’s role as a leader in quality spine care and beyond. The future holds promise for even greater integration of data-driven insights across all care cohorts, further solidifying a path toward excellence in healthcare delivery.
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