The National Neurosurgery Quality and Outcomes Database (N2QOD) A Collaborative North American Outcomes Registry to Advance Value-Based Spine Care
The National Neurosurgery Quality and Outcomes Database (N2QOD) A Collaborative North American Outcomes Registry to Advance Value-Based Spine Care
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DOI：
10.1097/brs.0000000000000579
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发表时间：
2014-10-15
期刊：
影响因子：
3
通讯作者：
McGirt, Mathew J.
中科院分区：
文献类型：
--
作者：
Asher, Anthony L.;Speroff, Ted;McGirt, Mathew J.
研究设计.国家前瞻性观察登记目标。描述我们在国家神经外科质量和结局数据库（N（2）QOD）中的初步经验，这是一个国家协作注册的腰部手术后质量和结局报告。所有主要的卫生保健利益攸关方现在都需要关于医疗服务价值的客观数据。脊柱疾病的手术治疗在最近基于价值的讨论中面临着特别的审查，这在很大程度上是由于这些手术的成本和应用的急剧增长。可靠的数据是理解所提供的医疗保健价值的基础。临床登记越来越多地用于提供这样的数据。N（2）QOD是一项前瞻性观察登记研究，旨在为脊柱外科医生进行的最常见腰椎手术建立风险调整后的预期发病率和1年结局;为实践小组和医院提供即时基础设施，以实时分析其30天发病率和死亡率以及3个月和12个月的质量数据;生成外科医生、实践和专业特定的质量和有效性数据;并生成全国范围内特定手术治疗的质量和有效性数据。在其运行的前2年，N（2）QOD已被证明是一个强大的数据收集平台，有助于证明腰椎难治性疾病手术干预的客观质量。在常规实践中，腰椎手术在组平均水平上被认为是安全有效的。使用经验证的结局指标，患者亚组未报告改善。在个体患者中观察到治疗反应的实质性差异。N（2）QOD现在被定位为确定患者变量对特定临床和患者报告结局的综合贡献。这些分析将最终促进共同决策，并鼓励有效地分配医疗资源，从而显着推进脊柱护理的价值范式。
Study Design. National Prospective Observational RegistryObjective. Describe our preliminary experience with the National Neurosurgery Quality and Outcomes Database (N(2)QOD), a national collaborative registry of quality and outcomes reporting after low back surgery.Summary of Background Data. All major health care stakeholders are now requiring objective data regarding the value of medical services. Surgical therapies for spinal disorders have faced particular scrutiny in recent value-based discussions, in large part due to the dramatic growth in the cost and application of these procedures. Reliable data are fundamental to understanding the value of delivered health care. Clinical registries are increasingly used to provide such data.Methods. The N(2)QOD is a prospective observational registry designed to establish risk-adjusted expected morbidity and 1-year outcomes for the most common lumbar surgical procedures performed by spine surgeons; provide practice groups and hospitals immediate infrastructure for analyzing their 30-day morbidity and mortality and 3- and 12-month quality data in real-time; generate surgeon-, practice-, and specialty-specific quality and efficacy data; and generate nationwide quality and effectiveness data on specific surgical treatments.Results. In its first 2 years of operation, the N(2)QOD has proven to be a robust data collection platform that has helped demonstrate the objective quality of surgical interventions for medically refractory disorders of the lumbar spine. Lumbar spine surgery was found to be safe and effective at the group mean level in routine practice. Subgroups of patients did not report improvement using validated outcome measures. Substantial variation in treatment response was observed among individual patients.Conclusion. The N(2)QOD is now positioned to determine the combined contribution of patient variables to specific clinical and patient-reported outcomes. These analyses will ultimately facilitate shared decision making and encourage efficient allocation of health care resources, thus significantly advancing the value paradigm in spine care.