Health Policy Research

Findings coming soon!

STEP Outreach Program:

According to the Pediatric Orthopaedic Society of North America (POSNA), Scoliosis Research Society (SRS), American Academy of Orthopaedic Surgeons (AAOS), and American Academy of Pediatrics (AAP) Adolescent Idiopathic Scoliosis (AIS) is found in girls from ages 10-12 and boys 13-14 and screening should be performed during this crucial time when growth spurts can progressively make spinal deformities worse.

Left unchecked, scoliosis can progress to the point where major surgery is required. With early detection and management, scoliosis screenings allows health care professionals to effectively treat this disease, often preventing surgery. However, the cost-effectiveness of screening remains unclear on a systematic level. One critical determinant of screening cost-effectiveness may be its impact on post-screening care in populations with poor access/significant barriers to medical care. 

We aim to leverage the STEP outreach program (run by a nurse doing school screenings across the Bay Area) to conduct a study that intends to elaborate the outcomes and barriers to care following scoliosis screening in various populations, in order to better define the cost-effectiveness of these programs.

Led by: Dr. John Vorhies and Joanna Langner.

Prescribing Patterns of Opiates in Pediatric Orthopaedics

The opiate epidemic in U.S. children mirrors that of adults: nearly one-quarter of all high school seniors have used opioids—over half of whom used for nonmedical reasons. Over 1 in 5 children between the ages of 12-17 years without chronic disease report opioid use, as have 15% of children aged 2-17 years.  While adult orthopaedics has been shown to play a significant role in opiate prescriptions, in pediatric orthopaedics, patterns of opiate use are less documented. This lies contrary to the fact that the pediatric orthopaedic population—in particular, the amateur athlete—may be at disproportionate risk of opiate exposure. Amateur athletes are at up to 10 and 4 times higher risk of medical and nonmedical opioid misuse relative to non-athletes. Minimal evidence exists on prescription, dosing, and usage of opiates in the pediatric orthopaedic population. Thus, this project seeks to evaluate opioid prescription patterns by pediatric orthopaedic surgeons across multiple treatment cohorts using a nationally representative database.

Initiative for Quality Research in Orthopaedics (AAOS)

Despite the robust nature of the biomedical research universe, it has been estimated that 85% of the published research is false—leading to the coining of the “reproducibility crisis.” Meanwhile, trends in clinical care have moved towards “evidence-based medicine (EBM),” leaning heavily on the published literature to justify the course of patient care. Orthopaedics in particular has witnessed several controversies involving clinical practices adopted based on research that later was revealed to be biased. Thus, to the extent that EBM is inexorably tethered to research data for clinical decision-making, the veracity of research is a prerequisite for ideal patient care. This initiative within our group focuses on designing protocols and disseminating best practices for the interpretation and implementation of high-quality research.

Led by: Dr. Kevin Shea and Eli Cahan

Optimization of the Supply Chain in Pediatric Orthopaedics

The healthcare spend in the United States represents 18% of the gross domestic product (GDP), and is unsustainable based on projected growth rates. While the Affordable Care Act catalyzed a move towards reimbursement based on outcomes rather than volume, fee-for-quality models have only emerged for a minority of procedures between payors and provider systems. One explanatory factor relates to procedure cost magnitude and variability incurred by provider systems. Accordingly, our team is working on a portfolio of projects aiming to reduce cost variability for surgical procedures—including development of streamlined pathways for perioperative care, as well as the design of risk-sharing initiatives with payors and suppliers.

Led by: Dr. Shea and Eli Cahan

Cahan EM, Chawla A, Shea KG. Supply Chain Optimization and Waste Reduction. JAMA. 2020;323(6):572–573. doi:10.1001/jama.2019.20854

Details coming soon!