165. Impact of a centralized spinal orthoses program on cost of care in the hospital setting

BACKGROUND CONTEXT Off-the-shelf (OTS) adjustable spinal orthoses benefit hospital patients in their recovery from spinal fractures, traumatic spinal injuries, and spinal surgery. Best practice routinely recommends physical therapy for early mobilization and training patients in spinal orthosis management. Medicare and private insurance increasingly place hospitals under economic pressure to provide excellent patient care with less financial resources. A gap exists in the literature that explores the most cost-effective model for orthosis fitting and delivery. At the study facility, a level 1 trauma center, we experienced delivery delays by the external vendor that prevented the timely mobilization of patients and impacted discharge. These challenges led us to consider alternative models for providing OTS spinal orthoses to improve patient care. PURPOSE To investigate the cost-effectiveness and process efficiency of an external vendor provided OTS spinal orthoses program compared to a hospital-based physical therapist provided OTS spinal orthoses program. STUDY DESIGN/SETTING A retrospective study to examine clinical changes pre- and postimplementation of a centralized OTS spinal orthoses program managed by the physical therapy department in a hospital setting. PATIENT SAMPLE Study compared 100 patients from preprogram to 120 patients in the postprogram. OUTCOME MEASURES N/A METHODS We developed an OTS spinal orthoses program managed by the physical therapy (PT) department at our facility. In the program, the PT department stocked three adjustable sizes of lumbar spinal orthoses (LSO) and thoracic lumbar spinal orthoses (TLSO). Physical therapists fit the brace and mobilize the patient during the first PT visit. We compared the new program to the previous program by evaluating the time to delivery of the orthosis, time to mobilization by physical therapy, length of stay and cost of care between the two programs for trauma, surgical, and all patients - statistical analysis used parametric and nonparametric tests as appropriate for the data. P-values less than 0.05 identified significant differences. RESULTS Time to mobilization of patients by physical therapy significantly decreased when comparing the two programs (all patients=14.6 hrs [p=6.56E-9] trauma patients=16 hrs [p=9.6E-6]). The length of stay decreased by an average of 9.2 hrs (p=n.s.). The new program resulted in an average charge reduction of $2026.50 (p CONCLUSIONS These findings demonstrate how a PT managed centralized spinal orthoses program can facilitate rapid mobilization of patients and reduce the length of stay of our patients. The program improved the quality of care and reduced costs associated with the mobilization of patients requiring OTS spinal orthoses. FDA DEVICE/DRUG STATUS DeRoyal Spinal Orthoses (Approved for this indication)