McGirt Matthew J, Parker Scott L, Asher Anthony L, Norvell Dan, Sherry Ned, Devin Clinton J
*Carolina Neurosurgery and Spine Associates, Charlotte, NC †Department of Orthopedic & Neurosurgery, Vanderbilt Medical Center, Nashville, TN; and ‡Spectrum Research Inc., Tacoma, WA.
Spine (Phila Pa 1976). 2014 Oct 15;39(22 Suppl 1):S117-28. doi: 10.1097/BRS.0000000000000552.
Literature review and case example.
Describe methodological considerations of spine surgery registries. Review existing spine surgery registries. Describe the Vanderbilt Prospective Spine Registry (VPSR) as a case example and demonstrate its impact on comparative effectiveness research, value analysis, quality improvement, and practice-based learning.
To bend the cost curve and ultimately achieve sustainability in health care, medical providers and surgical treatments of the highest quality and effectiveness must be preferentially used and purchased. As the current US health care environment continues to evolve, it will be essential for all spine clinicians to understand and be facile with the principles of evidence-based health care reform.
We describe the methodological considerations of spine surgery registries, review the literature to describe existing spine surgery registries, and discuss the VPSR as a case example.
We were able to obtain detailed information on 13 existing spine surgery registries through various internet-based resources. Of the 13, 2 registries had start dates before 2000, 3 between 2001 and 2005, 5 starting in 2006, and 3 were indeterminate. Follow-up rates were in the range from 22% to 79%, with longer follow-up times consistently producing lower follow-up rates.
Prospective, longitudinal, patient-reported outcomes registries are powerful tools that allow measurement of cost, safety, effectiveness, and health care value across clinically meaningful episodes of care. Registries entirely based on claims or billing data, safety measures alone, process measures, or other proxies of outcome offer valuable insights, but do not provide comprehensive data to drive patient-centered value-based reform. As more spine-focused registries emerge and their integration into the US health care delivery evolve, the evidence to power value-based reform will be enabled.
文献综述与病例示例。
描述脊柱外科手术登记系统的方法学考量。回顾现有的脊柱外科手术登记系统。以范德比尔特前瞻性脊柱登记系统（VPSR）为例进行描述，并展示其对比较效果研究、价值分析、质量改进及基于实践的学习的影响。
为扭转成本曲线并最终实现医疗保健的可持续性，必须优先使用和购买质量与效果最佳的医疗服务提供者和手术治疗。随着当前美国医疗保健环境不断演变，所有脊柱临床医生理解并熟练掌握循证医疗保健改革的原则至关重要。
我们描述脊柱外科手术登记系统的方法学考量，回顾文献以描述现有的脊柱外科手术登记系统，并以VPSR为例进行讨论。
我们通过各种基于互联网的资源获取了13个现有脊柱外科手术登记系统的详细信息。在这13个系统中，2个登记系统的起始日期在2000年之前，3个在2001年至2005年之间，5个始于2006年，3个情况不明。随访率在22%至79%之间，随访时间越长，随访率通常越低。
前瞻性、纵向、患者报告结局登记系统是强大的工具，可在具有临床意义的护理阶段衡量成本、安全性、有效性和医疗保健价值。完全基于索赔或计费数据、仅安全措施、过程措施或其他结局替代指标的登记系统能提供有价值的见解，但无法提供全面数据以推动以患者为中心的基于价值的改革。随着更多专注于脊柱的登记系统出现，且它们融入美国医疗保健服务的进程不断发展，推动基于价值的改革的证据将得以形成。
