Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Neurosurgery. 2018 Sep 1;83(3):333-344. doi: 10.1093/neuros/nyx408.
Quality improvement, value-based care delivery, and personalized patient care depend on robust clinical, financial, and demographic data streams of neurosurgical outcomes. The neurosurgical literature lacks a comprehensive review of large national databases.
To assess the strengths and limitations of various resources for outcomes research in neurosurgery.
A review of the literature was conducted to identify surgical outcomes studies using national data sets. The databases were assessed for the availability of patient demographics and clinical variables, longitudinal follow-up of patients, strengths, and limitations.
The number of unique patients contained within each data set ranged from thousands (Quality Outcomes Database [QOD]) to hundreds of millions (MarketScan). Databases with both clinical and financial data included PearlDiver, Premier Healthcare Database, Vizient Clinical Data Base and Resource Manager, and the National Inpatient Sample. Outcomes collected by databases included patient-reported outcomes (QOD); 30-day morbidity, readmissions, and reoperations (National Surgical Quality Improvement Program); and disease incidence and disease-specific survival (Surveillance, Epidemiology, and End Results-Medicare). The strengths of large databases included large numbers of rare pathologies and multi-institutional nationally representative sampling; the limitations of these databases included variable data veracity, variable data completeness, and missing disease-specific variables.
The improvement of existing large national databases and the establishment of new registries will be crucial to the future of neurosurgical outcomes research.
质量改进、基于价值的医疗服务提供和个性化患者护理都依赖于强大的神经外科临床、财务和人口统计学结果数据流。神经外科文献缺乏对大型国家数据库的综合评估。
评估神经外科研究其成果的各种资源的优缺点。
对文献进行综述，以确定使用国家数据集的外科手术结果研究。评估数据库中患者人口统计学和临床变量、患者的纵向随访、优势和局限性的可用性。
每个数据集包含的独特患者数量从数千（质量结果数据库[QOD]）到数亿（市场扫描）不等。具有临床和财务数据的数据库包括 PearlDiver、Premier Healthcare Database、Vizient Clinical Data Base and Resource Manager 和 National Inpatient Sample。数据库收集的结果包括患者报告的结果（QOD）；30 天发病率、再入院和再次手术（国家手术质量改进计划）；以及疾病发病率和疾病特异性生存（监测、流行病学和最终结果-医疗保险）。大型数据库的优势包括大量罕见的病理和多机构全国代表性抽样；这些数据库的局限性包括数据真实性和完整性的变化以及缺少疾病特异性变量。
改进现有的大型国家数据库和建立新的登记处对于神经外科研究其成果的未来至关重要。
