Mission: Explore variation in spinal surgery in Idaho. According to the Dartmouth Atlas Project, spinal surgery is four times greater in Idaho than elsewhere in the country. Is this appropriate care? Or inappropriate variation? Use scientific evidence to help answer these questions.

Concept: Identify a clinical group working in spine care who is interested in exploring appropriate and inappropriate care using an evidence-based approach. Provide them with training and support with a goal of creating a successful evidence-based clinical improvement project should change be desirable. Learnings will be applicable to other projects, plus team members will be able to facilitate similar projects with other clinical groups within the care system.

Delfini Role: Provide training, facilitation and support to the team to conduct the project and to effect both clinical and evidence-based process change.

An article about the project was published in the Idaho Statesman, Thursday, July 20, 2006, by Dr. Doug Dammrose, Senior Vice President & Medical Director of Blue Cross of Idaho

Testimonial: According to the Dartmouth Atlas Project, lumbar spine surgery is four times greater in Idaho than most areas of the country. Recently the Delfini Group conducted two evidence-based training sessions where Idaho spine surgeons actively participated in evaluating the evidence regarding surgery and other modalities for lumbar back pain and discussed ways to improve patient care in this area.

I believe the evidence-based approach used by Delfini is the right way to approach inappropriate variation in healthcare. I fully support Delfini’s step-wise approach to assessing medical technologies.

If we are to assure that our patients receive appropriate care, we as health care professionals must be able to search for and critically appraise the medical literature and commit to a statement about the quality of the evidence before making recommendations to others. Only then can we have informed discussions with our patients and colleagues about reasonable management strategies. One of the biggest problems in healthcare is that new diagnostic and therapeutic interventions are instituted without the support of good science.

I can highly recommend the Delfini faculty:

• They were extremely well-prepared and knowledgeable about applied EBM
  The lectures and exercises provided a comfortable, non-threatening environment and were well received by the spine surgeons.
• They are enthusiastic presenters, knowledgeable, and clearly dedicated to improving clinical care through the appropriate use of science.

Doug Dammrose, MD
Senior Vice President & Medical Director of Blue Cross of Idaho

"Helping Our Patients: An Evidence- and Value-based Initiative to Quality Spinal Care:" Essentials

June 23 & 24, 2006

The Blue Cross of Idaho Foundation for Health, in collaboration with the Idaho-based NeuroSciences Group, and with support through an educational grant from Medtronic, Inc., sponsored a two-day basic training course on Evidence-Based Medicine conducted by Delfini. Attendees were enthusiastic about the conference and their learnings. Key studies of interest in spine care were identified and critically appraised for validity and usefulness by the group.

"Helping Our Patients: An Evidence- and Value-based Initiative to Quality Spinal Care:" Advanced Concepts

July 21 & 22, 2006

With continued collaboration with the Idaho-based NeuroSciences Group, and with support from Medtronic, Inc., the Blue Cross of Idaho Foundation for Health sponsored a second two-day intensive educational conference conducted by Delfini. More key studies were evaluated and the group discussed potential areas of interest for conducting a clinical improvement project.

Phase III: Explore Clinical Improvement Topics

July 22, 2006

The group agreed to reconvene to explore various projects which could improve care for patients using their new skills and tools. Stay tuned for updates....

Blue Cross of Idaho Spinal Care Project 2006

We applaud Blue Cross of Idaho, the NeuroSciences Group and Medtronic for their willingness to explore a difficult area and for their dedication to exploring how to best provide quality care to patients. We would like to recognize Dr. Doug Dammrose, Senior Vice President & Medical Director of Blue Cross of Idaho, and Dr. James Morland of the NeuroSciences Group for their vision in pursuing an evidence-based approach to patient care, and we would like to recognize Medtronic in their striving to find ways to create valid research designs in a challenging area.

In the health care environment we came from, which was a consumer-governed, staff-model health maintenance organization, there were natural alignments for providing quality care for patients. In the worlds of fee-for-service, insurance and industry, there are potential conflicts of interest and these natural alignments generally do not exist. The Idaho Spine Care Project is an important one not only for helping improve patient care, but for providing a model of how such alignments might be forged by these various groups to provide an evidence- and value-based approach to care with the patient at its heart.

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