University of Western Ontario, London, Ontario, Canada.
University of Calgary, Calgary, Alberta, Canada.
Spine (Phila Pa 1976). 2018 Feb 15;43(4):275-280. doi: 10.1097/BRS.0000000000002309.
Systematic review.
To elucidate how performance indicators are currently used in spine surgery.
The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators.
MEDLINE, CINAHL Plus, EMBASE, and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016. All full text articles were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the three criteria of established standard, exclusion/risk adjustment, and benchmarking to determine if it constituted a performance indicator.
The initial search yielded 85 results among which two relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided five additional reports which in turn led to six additional articles. A total of 27 full text articles and reports were retrieved and reviewed. We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken to craft the first performance indicator in spine surgery.
The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but requires benchmarking to truly measure performance.
系统评价。
阐明目前在脊柱外科中如何使用绩效指标。
《患者保护与平价医疗法案》（Patient Protection and Affordable Care Act）通过引入基于医院的价值采购，为医疗保健必须通过向患者提供价值的理念提供了重要动力。实施这一新模式的关键是通过绩效指标显著衡量这种价值。
通过 MEDLINE、CINAHL Plus、EMBASE 和 Google Scholar 搜索报告特定于脊柱外科使用绩效指标的研究。我们遵循 Prisma-P 系统评价方法，对 1980 年 1 月至 2016 年 7 月的条目进行了系统评价。然后，对所有全文文章进行审查，以确定文章中发表的任何绩效衡量标准。然后，根据既定标准、排除/风险调整和基准测试这三个标准来检查该衡量标准，以确定其是否构成绩效指标。
最初的搜索产生了 85 个结果，其中确定了两项相关研究。扩展搜索在数据库中总共提供了 865 个引文，其中确定了 15 篇新文章。灰色文献搜索提供了另外 5 份报告，反过来又确定了另外 6 篇文章。共检索和审查了 27 篇全文文章和报告。我们无法确定绩效指标。根据它们缺乏多少标准来组织呈现绩效衡量标准的文章。我们进一步研究了制定脊柱外科首个绩效指标的下一步措施。
应用于脊柱外科的绩效衡量科学仍处于起步阶段。目前在临床环境中使用的结果指标需要改进才能成为绩效指标。当前的注册工作为提供了必要的基础，但需要进行基准测试才能真正衡量绩效。
