Spine Surgery Patient Navigators (2024-2025)

Background

Chronic back pain is one of the top five leading causes of disability worldwide. In the United States, about one in four adults has chronic back pain at any given time. 

However, studies have demonstrated that patients of certain demographics have a higher burden of disease. Low-income patients have longer hospital stays after surgery and more frequently go to the emergency room after discharge. Non-Hispanic Black people and Hispanic people are undertreated for pain and less likely to undergo surgery, despite reporting more severe back pain and disability. These groups may also face an increased risk of complications during or after back surgery.

Optimal outcomes are achieved when the management of back pain is multimodal. Interventions providing social and emotional support after surgery can decrease stress, anxiety and hospital length of stay, while physical movement after surgery decreases length of stay and risk of complications.

Project Description

Building on the work of the 2023-2024 team, this project team aims to improve health outcomes for patients undergoing spine surgery. The team will work directly with surgical spine patients at Duke Hospital with three primary aims:

1. Improve patients’ access to and utilization of existing healthcare resources. Barriers to optimal surgical care and MyChart utilization will be identified at the first appointment with a spine surgeon. All patients meeting inclusion criteria will receive a handout of community resources. For patients not enrolled in MyChart, team members will provide education on patient portal use, including enrolling, reviewing results and messaging providers.
2. Expand the social support network of patients undergoing spine surgery. Preoperatively, team members will meet patients and identify goals of care in conjunction with their spine provider. Postoperatively, team members will serve as an additional liaison between the patient and providers via biweekly calls, during which they will check in on the patient’s mental and physical health.
3. Improve patients’ physical status and mobility in the immediate postoperative period. Team members will visit their patients each day postoperatively, assist in completing postoperative mobility exercises, and discuss and demonstrate the recommended home mobility exercises. Further, they will confirm that patients have access to a physical therapist and can attend appointments.

Anticipated Outputs

Abstracts for poster or oral presentation at a conference and Duke Orthopedic Surgery research day; grant proposals; publication submission; presentation to Duke Spine Patient Advocacy Group; presentation at Neurosurgery Grand Rounds

Student Opportunities

Ideally, this project team will include 5 graduate students and 10 undergraduate students with backgrounds in neuroscience, public policy, public health, biology or biological sciences and/or global health. Students with interests in community engagement, clinical and quality improvement research, and achieving health equity are encouraged to apply, especially those from underrepresented racial and ethnic minorities. 

Team members will meet weekly to receive training in patient engagement, health disparities in spine surgery, back pain and mental health, patient portal utilization and understanding safety nets. Students will also break into subteams (“pods”) and be mentored closely by medical students. All students will work directly with patients and have opportunities to attend clinic visits and deepen their understanding of how socioeconomic factors impact a patient’s healthcare experience. Students will also benefit from learning from three guest speakers each semester who will discuss topics such as nonsurgical treatment of back pain, the opioid epidemic and health policy related to expanding access to surgical care.

Team members will have the opportunity to continue work in patient enrollment and engagement in Summer 2025. 

Timing

Fall 2024 – Summer 2025

• Fall 2024: Engage in training for patient engagement and learn about social determinants of health; continue patient enrollment
• Spring 2025: Student navigators continue to work with patients; students may shadow a spine provider; analyze data and prepare a summary of outcomes; present at neurosurgery grand rounds and orthopedic research day; submit project and findings for publication
• Summer 2025 (optional): Students will have the option to continue patient enrollment and engagement

Crediting

Academic credit available for fall and spring semesters; summer funding available

See earlier related team, Spine Surgery Patient Navigators (2023-2024).