Martin Ryan C, Petitt Jordan C, Pan Xuankang, Edwards Alyssa M, Desai Ansh D, Mahajan Uma V, Labak Collin M, Herring Eric Z, Mauria Rohit, Gordon Zachary, Pronovost Peter J, Smith Gabriel
University of Illinois College of Medicine, Peoria, Illinois, USA.
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
J Spine Surg. 2022 Mar;8(1):44-53. doi: 10.21037/jss-21-46.
Centers of excellence (COEs) are interdisciplinary healthcare organizations created with the goal of improving health/economic outcomes in medical treatment for both individuals and health systems, compared to traditionally structured counterparts. Multiple studies have highlighted both societal/individual burdens associated with back pain, underscoring the importance of identifying new avenues for improving both cost/clinical outcomes for this patient population. Here, we utilize available literature to better characterize the features of a spine COE at a tertiary care center and determine the impact of COEs on patient satisfaction and outcomes.
A systematic review describing spine COEs was performed. PubMed, OVID, Cochrane, Web of Science, and Scopus were utilized for electronic literature search. Data including institution, department, pathologies treated, patient satisfaction scores, patient outcomes, and descriptions of the COE, were extracted and analyzed by two reviewers per full-text article. Inclusion criteria consisted of literature describing the organization, purpose, or outcomes of a spine COE, all publication types (except technical/operative report), adult or pediatric patients, publication from inception through September 2021. Exclusion criteria consisted of articles that do not discuss spinal COEs, technical/operative reports, studies unavailable in English language, unavailable full text, or non-human subjects. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies.
Five hundred and sixty-seven unique publications were obtained from the literature search. Of these articles, 20 were included and 547 were excluded based on inclusion and exclusion criteria. Following full-text review of the 20 publications, 6 contained pertinent data. Quantitative data comparing COE versus non-COE was contradictory in comparing complication rates and episodic costs. Qualitative data included descriptions of spine COE features and cited improved patient care, technical advancements, and individualized care paths as positive aspects of the COE model. Mean risk of bias assessment was 3.67.
There is little evidence regarding if spine COEs provide an advantage over traditionally organized facilities. The current number and heterogeneity of publications, and lack of standardized metrics used to define a spinal COE are limiting factors. Spinal COE may offer higher value care, reduced complication rates and advancements in knowledge and technical skill.
卓越中心（COEs）是跨学科的医疗保健组织，其创建目的是与传统结构的同行相比，改善个体和医疗系统在医疗治疗中的健康/经济结果。多项研究强调了与背痛相关的社会/个体负担，凸显了为该患者群体寻找改善成本/临床结果新途径的重要性。在此，我们利用现有文献更好地描述三级医疗中心脊柱卓越中心的特征，并确定卓越中心对患者满意度和结果的影响。
进行了一项描述脊柱卓越中心的系统评价。利用PubMed、OVID、Cochrane、科学网和Scopus进行电子文献检索。两名审阅者对每篇全文文章提取并分析包括机构、科室、治疗的病理情况、患者满意度评分、患者结果以及卓越中心描述等数据。纳入标准包括描述脊柱卓越中心的组织、目的或结果的文献，所有出版类型（技术/手术报告除外），成人或儿科患者，从创刊至2021年9月的出版物。排除标准包括不讨论脊柱卓越中心的文章、技术/手术报告、非英文研究、无法获取全文或非人类受试者研究。使用纽卡斯尔-渥太华质量评估量表评估纳入研究的质量。
通过文献检索获得567篇独特的出版物。其中，根据纳入和排除标准，20篇被纳入，547篇被排除。对这20篇出版物进行全文审查后，6篇包含相关数据。比较卓越中心与非卓越中心的定量数据在并发症发生率和发作成本比较方面相互矛盾。定性数据包括脊柱卓越中心特征的描述，并将改善患者护理、技术进步和个性化护理路径列为卓越中心模式的积极方面。平均偏倚风险评估为3.67。
关于脊柱卓越中心是否比传统组织的机构具有优势的证据很少。当前出版物的数量和异质性以及缺乏用于定义脊柱卓越中心的标准化指标是限制因素。脊柱卓越中心可能提供更高价值的护理、降低并发症发生率以及知识和技术技能的进步。
