Friday, September 28, 2018 8:00 AM–9:00 AM interdisciplinary spine forum: abstract presentations: 141. Global spine care initiative: model of care and implementation plan

Abstract

BACKGROUND CONTEXT Spinal disorders contribute to the global burden of disease and are especially burdensome for medically underserved communities and low- and middle-income countries (LMIC). A model of care (MoC) that could be implemented in these regions may help to relieve this burden. PURPOSE The purpose of this study was to develop a MoC for spine-related complaints that could be implemented globally, especially in medically underserved areas and LMICs. A secondary purpose was to develop recommendations to implement this MoC at a local level. STUDY DESIGN/SETTING Expert consensus. METHODS The Global Spine Care Initiative (GSCI) development team applied an evidence-based and expert consensus process to develop a MoC. A seed document was created by the lead authors using published GSCI papers to inform the process, which included a classification of spine-related complaints, a spine care pathway, resources lists to deliver primary or secondary or tertiary spine care. Evidence-based papers by the GSCI on the topics of rural health, psychological and social factors for spine pain, prevention strategies, assessment of spine-complaints, noninvasive and invasive treatments for spine disorders also informed this process. An international and multidisciplinary team of 70 experts were invited. Survey invitations were sent through Survey Monkey. Each expert who accepted the invitation reviewed and provided input to the MoC. The document was revised and the revision was redistributed for additional review and input. Items with no change requests were classified as ‘agreement.’ The document was revised further and the final draft was agreed upon by all coauthors after three consensus rounds. RESULTS Sixty-six experts participated, representing 23 countries, major geographic regions, a wide range of professional roles, and organization types from across the continuum of care. The GSCI MoC principles include: biopsychosocial approach, person and patient-centered care, multifactorial and functional values, best practices, collaboration among participants, proactive health care, obtaining health metrics, and that it should be self-sustaining. The model is tiered to address the variety of needs of the local community: self-care and community preventive care (needs of the majority), primary spine care (needs of many), secondary spine care (needs of some), and tertiary spine care (needs of few). Each level of spine care is integrated with the other to conserve resources so the patient receives the best possible care. The implementation recommendations include: identifying spine care needs in the local community, establishing a feasible plan, small scale implementation then full implementation and program evaluation. These flexible steps can be applied in a variety of settings and are especially well-suited to areas with low resources. The model and implementation strategies are compatible with the World Health Organization global strategy on integrated and people-centered health services and are applicable specifically to spine care. CONCLUSIONS The GSCI MoC offers a practical model for spine care that may be implemented in any region but especially in underserved areas. The eight transformative principles assist with the implementation of the MoC. Due to the flexibility and recommendations for local-engagement of the implementation plan, this model also has the potential for scaling up.