The PIVOT Center Launches within the Department of Orthopaedic Surgery

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Affecting more than half of adults in the United States, low back pain, osteoarthritis and musculoskeletal trauma are the three most common musculoskeletal conditions leading to emergency department and physician visits and hospital stays. Nearly $800 billion, or about 5 percent of the U.S. economy, goes towards diagnosing, treating and managing musculoskeletal conditions.

“America spends more money on managing musculoskeletal conditions than it does on Social Security benefits for retired persons and their families. As people live longer and baby boomers age, this burden will continue to increase,” says Elena Losina, PhD, a Robert W. Lovett Professor of Orthopaedic Surgery in the Department of Orthopaedic Surgery at Brigham and Women’s Hospital.

The Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center

To help address these issues, the Brigham recently launched the Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center in the Department of Orthopaedic Surgery. The research conducted at the PIVOT Center helps policymakers, physicians and patients to maximize treatment health benefits while reducing the overall economic burden of musculoskeletal diseases.

The mission of the PIVOT Center is to use multidisciplinary research methods to inform the development of innovative procedures and improve the clinical and economic value of existing procedures. By establishing the value of technologic innovations in orthopaedics and disseminating evidence that informs treatment policy and care, the center aims to serve as a national hub for health policy research in orthopaedics and musculoskeletal disorders.

Dr. Losina leads the PIVOT Center as its founding director and is principal investigator of the NIH-funded Osteoarthritis Policy Model, which is designed to investigate the long-term clinical and economic impact of knee osteoarthritis and its treatment.

“Elena Losina is recognized internationally for her expertise in chronic disease modeling, cost-effectiveness analyses, and for melding clinical research methodologies across many clinical disciplines, from orthopaedics and osteoarthritis to global health,” says James Kang, MD, chair of the Brigham’s Department of Orthopaedic Surgery. “I am thrilled that Dr. Losina is spearheading this important initiative.”

PIVOT Facilitates Implementation of Value-Based Orthopaedic Care Delivery

The PIVOT Center is using innovative modeling methods that project findings of clinical research into long-term gains in quality-adjusted life expectancy for individuals with musculoskeletal diseases. The research conducted at the center guides clinicians and policymakers in their efforts to reduce pain and disability and improve quality of life for people with musculoskeletal conditions.

“The PIVOT Center facilitates implementation of value-based orthopedic care delivery,” explains Dr. Losina. “Ideally, treatment strategies for musculoskeletal disorders would be evaluated in large randomized trials. Such trials can only be conducted over short periods of time and at substantial cost. Model-based analyses overcome these challenges. Insurers, pharmaceutical companies and government agencies are recognizing the pivotal role of model-based evaluations. We live in an era of limited resources, and the primary goal of the PIVOT Center is to optimize the use of these resources by promoting value-based care that improves the well-being of patients.”

Key Initiatives at the PIVOT Center

One of the key directions of the PIVOT Center’s work is to use decision analysis modeling to help prioritize future clinical research and inform the research agenda of the Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), which aims to reduce the burden of orthopaedic diseases for individuals and society.

“The health care system faces unprecedented pressures, and the PIVOT Center helps us meet these challenges,” says Jeffrey N. Katz, MD, MSc, director of Research at the Department of Orthopaedic Surgery and director of OrACORe. “The research conducted at the PIVOT Center complements the research agenda of OrACORe.”

Initially, the PIVOT Center focused on clinical areas that included the low extremities and lumbar spine. The center uses the Osteoarthritis Policy (OAPol) model, a computer simulation model of knee osteoarthritis, to address questions about the value of total knee replacement in individuals with comorbidities, including morbid obesity and diabetes as well as some types of cancer.

The Center has developed a new model called FACETS (Finding Appropriate Cost-Effective Treatments for the Spine) that focuses on defining the value for surgical and non-surgical treatments for patients with lumbar spinal stenosis, disc problems and degenerative spondylolisthesis.

“The PIVOT Center has tremendous utility for all stakeholders in health care and policy and will help us optimize the value of care we provide for our patients,” says Dr. Kang. “The research conducted at the center is attracting the best fellows and residents by providing them an opportunity to learn methods of health policy evaluation and collaborate with internationally renowned experts.”