{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:35:20Z","timestamp":1761824120326},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2017,7,1]],"date-time":"2017-07-01T00:00:00Z","timestamp":1498867200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec>\n            <jats:title>Introduction:<\/jats:title>\n            <jats:p>Episode-based bundled payment (EBBP) is an alternative model of health-care payment that aims to align providers\u2019 and hospitals\u2019 incentives toward delivery of more coordinated, higher quality, and lower cost care. EBBP programs have been studied for numerous adult conditions over the past decade, yet there have been no studies exploring the use of EBBP in pediatric conditions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>This article explores the feasibility of EBBP for a relatively common, costly, pediatric surgical procedure: spinal fusion for adolescent idiopathic scoliosis. We begin with a review of successful EBBP programs in the United States. We then apply American College of Surgeons criteria for bundled payment episode selection to identify benefits and challenges of using EBBP for this condition.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>We identify several features of pediatric spinal fusion that make it an attractive EBBP target: high variability in costs with multiple distinct targets for cost reduction, high variability in quality across hospitals, and proven methods for improvement via application of standardized, evidence based pathways. We find that challenges to EBBP may arise due to the relatively low incidence of the procedure, which limits overall savings to the health-care community.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Our results suggest that spinal fusion for adolescent idiopathic scoliosis is an attractive pediatric target for EBBP, with potential benefits to patients, providers, health systems, and payers if limitations in procedure volume and administrative expense are overcome. The framework presented may also be useful for analyzing feasibility of EBBP for other pediatric conditions.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pq9.0000000000000028","type":"journal-article","created":{"date-parts":[[2019,6,11]],"date-time":"2019-06-11T20:47:53Z","timestamp":1560286073000},"page":"e028","source":"Crossref","is-referenced-by-count":5,"title":["Feasibility of Episode-Based Bundled Payment for a Pediatric Surgical Condition: Posterior Spinal Fusion"],"prefix":"10.1097","volume":"2","author":[{"given":"Erin E.","family":"Shaughnessy","sequence":"first","affiliation":[{"name":"Department of Surgery, James M. Anderson Center for Health Systems Excellence, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Sturm","sequence":"additional","affiliation":[{"name":"Department of Surgery, James M. Anderson Center for Health Systems Excellence, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Sitzman","sequence":"additional","affiliation":[{"name":"Department of Surgery, James M. Anderson Center for Health Systems Excellence, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20230930","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1056\/NEJMp0906121","article-title":"Building a bridge from fragmentation to accountability\u2014the Prometheus Payment model.","volume":"361","author":"de Brantes","year":"2009","journal-title":"N Engl J Med"},{"issue":"8 Suppl","key":"R2-20230930","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.arth.2013.07.012","article-title":"Bundled payments for care improvement initiative: the next evolution of payment formulations: AAHKS Bundled Payment Task Force.","volume":"28","author":"Froimson","year":"2013","journal-title":"J Arthroplasty"},{"key":"R3-20230930","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1007\/s11999-013-3034-3","article-title":"Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction.","volume":"472","author":"Bozic","year":"2014","journal-title":"Clin Orthop Relat Res"},{"key":"R7-20230930","doi-asserted-by":"crossref","DOI":"10.1097\/BPO.0000000000000601","article-title":"Use of a novel pathway for early discharge was associated with a 48% shorter length of stay after posterior spinal fusion for adolescent idiopathic scoliosis.","author":"Fletcher","year":"2017;37:92\u201397","journal-title":"J Pediatr Orthop"},{"key":"R8-20230930","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-1568","article-title":"Rapid recovery pathway after spinal fusion for idiopathic scoliosis.","author":"Muhly","year":"2016;137:e20151568","journal-title":"Pediatrics"},{"key":"R9-20230930","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1097\/BRS.0000000000000378","article-title":"Spinal surgery: variations in health care costs and implications for episode-based bundled payments.","volume":"39","author":"Ugiliweneza","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"key":"R10-20230930","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/BPB.0000000000000274","article-title":"Predictors of variability in the length of surgery of posterior instrumented arthrodesis in patients with adolescent idiopathic scoliosis.","volume":"25","author":"Heller","year":"2016","journal-title":"J Pediatr Orthop B"},{"key":"R11-20230930","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s11832-014-0587-y","article-title":"Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis.","volume":"8","author":"Fletcher","year":"2014","journal-title":"J Child Orthop"},{"key":"R13-20230930","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1002\/jhm.144","article-title":"Pediatric hospitalist comanagement of spinal fusion surgery patients.","volume":"2","author":"Simon","year":"2007","journal-title":"J Hosp Med"},{"key":"R14-20230930","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1002\/jhm.2266","article-title":"Pediatric hospitalist comanagement of surgical patients: structural, quality, and financial considerations.","volume":"9","author":"Rappaport","year":"2014","journal-title":"J Hosp Med"},{"key":"R15-20230930","doi-asserted-by":"crossref","first-page":"e505","DOI":"10.1542\/peds.2014-3322","article-title":"Implementation of postoperative respiratory care for pediatric orthopedic patients.","volume":"136","author":"Shaughnessy","year":"2015","journal-title":"Pediatrics"},{"key":"R16-20230930","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1097\/BRS.0000000000000365","article-title":"The incidence and risk factors for short-term morbidity and mortality in pediatric deformity spinal surgery: an analysis of the NSQIP pediatric database.","volume":"39","author":"Pugely","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"key":"R17-20230930","doi-asserted-by":"crossref","first-page":"e1353","DOI":"10.1542\/peds.2015-0580","article-title":"Surgical site infection reduction by the solutions for patient safety hospital engagement network.","volume":"136","author":"Schaffzin","year":"2015","journal-title":"Pediatrics"}],"container-title":["Pediatric Quality &amp; Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/01949578-201707000-00001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T08:01:25Z","timestamp":1696060885000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01949578-201707000-00001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":13,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1097\/pq9.0000000000000028","relation":{},"ISSN":["2472-0054"],"issn-type":[{"value":"2472-0054","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7]]}}}