The Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP): A Surgeon-Led Approach to Quality and Safety
The Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP): A Surgeon-Led Approach to Quality and Safety
复制标题
脊柱手术护理和结果评估计划 (Spine SCOAP)：外科医生主导的质量和安全方法
作者：
Michael J. Lee;N. Shonnard;Farrokh R. Farrokhi;Dean Martz;J. Chapman;R. Baker;J. Hsiang;C. Lee;Ray Gholish;D. Flum
研究设计.脊柱手术前瞻性登记研究。Objective.确定脊柱手术的利用率、护理过程和结局的变化，以提高全州的质量和安全性。背景数据摘要。美国和国际上不同地区选择性脊柱手术的利用和结局的差异已成为关键评价的一个日益关注的焦点。2011年，华盛顿州的外科医生创建了脊柱手术护理和结局评估计划，以解决脊柱手术使用、过程和结局的可变性。方法.前瞻性队列研究，来自20家医院的连续脊柱融合病例和30%其他脊柱手术样本（2011-2013）。使用10个季度的数据开发Logistic回归模型，以确定与合并不良事件相关的因素，包括索引医院死亡、再干预和不需要干预的不良事件，然后应用于最后2个季度的患者。结果共有10，166例（58.9 ± 13.4岁，52.2%为女性）接受手术，包括3767例（37%）腰椎手术和6399例（63%）颈椎手术。在所有患者中，75.3%的队列患者接受了脊柱融合，其中92.5%的患者描述了神经系统症状，被归类为有神经系统症状的患者的基线肢体疼痛数字评定量表（NRS）评分为5.9。背痛的NRS平均评分为5.9，平均奥斯韦斯特里残疾指数/颈部残疾指数为44。在接受融合手术的患者中，吸烟率（范围，0%-40%）和合并不良事件发生率存在显著的研究中心间差异，其中10家医院的观察/预期比率显著较低，3家医院的观察/预期比率显著较高。结论脊柱手术护理和结局评估计划确定了脊柱手术相关适应症、护理过程和结局的显著差异。这种变化表明需要继续监测举措，并指出质量改进和研究的机会。证据等级：2
Study Design. Prospective registry of spine surgery. Objective. To identify variation in utilization, processes of care, and outcomes in spine surgery to improve statewide quality and safety. Summary of Background Data. Variability in the utilization and outcomes of elective spine surgery across different regions in the United States and internationally has become a growing focus of critical evaluation. In 2011, surgeons in Washington State created the Spine Surgical Care and Outcomes Assessment Program to address variability in use, process, and outcome of spine surgery. Methods. Prospective cohort study from consecutive spine fusion cases and 30% sampling of other spine procedures from up to 20 hospitals (2011–2013). Logistic regression models were developed using data from 10 quarters to determine factors associated with combined adverse events inclusive of index hospital death, reintervention, and adverse events not requiring intervention, and then applied to patients in the last 2 quarters. Results. A total of 10,166 (58.9 ± 13.4 yr, 52.2% females) underwent surgery including 3767 (37%) lumbar and 6399 (63%) cervical procedures. Of the total, 75.3% of the cohort had a spine fusion and among those, neurological symptoms were described in 92.5% of patients, with baseline limb pain numeric rating scale (NRS) scores of 5.9 among those classified as having neurological symptoms. The NRS mean score for back pain was 5.9 with a mean Oswestry Disability Index/Neck Disability Index of 44. There was significant intersite variation in rates of cigarette smoking among patients undergoing fusion surgery (range, 0%–40%) and rates of combined adverse events with 10 hospitals having a significantly lower observed/expected ratio and 3 having a significantly greater observed to expected ratio. Conclusion. Spine Surgical Care and Outcomes Assessment Program identified significant variability in the indications, process of care, and outcomes related to spine surgery. This variability indicates the need for continued surveillance initiatives and point to opportunities for quality improvement and research. Level of Evidence: 2
影响因子：
120.7
作者：
Deyo, Richard A.;Mirza, Sohail K.;Martin, Brook I.;Kreuter, William;Goodman, David C.;Jarvik, Jeffrey G.
通讯作者：
Jarvik, Jeffrey G.
创建外科学习医疗保健系统：华盛顿州外科护理和结果评估计划 (SCOAP)，为期 5 年。
影响因子：
3.8
作者：
SCOAPCollaborative,WritingGroupfortheSCOAPCollaborative;Kwon,Steve;Florence,Michael;Grigas,Peter;Horton,Marc;Horvath,Karen;Johnson,Morrie;Jurkovich,Gregory;Klamp,Wendy;Peterson,Kristin;Quigley,Terence;Raum,William;Rogers,Ter
通讯作者：
Rogers,Ter
影响因子：
--
作者：
Kwon, Steve;Morris, Arden;Billingham, Richard;Frankhouse, Joseph;Horvath, Karen;Johnson, Morrie;McNevin, Shane;Simons, Anthony;Symons, Rebecca;Steele, Scott;Thirlby, Richard;Whiteford, Mark;Flum, David R.
通讯作者：
Flum, David R.