Introduction: Quality measurement registry platforms lie at the center of all emerging evidence-driven reform models and will be used to inform all decision makers in healthcare delivery. In March of 2012, the National Neurosurgery Quality and Outcomes Database (N2QOD) Lumbar Pilot was launched with the aim to develop a valid and accurate platform to measure the safety and effectiveness of spine care in everyday neurosurgical and orthopedic practice.

Methods: A nationwide, web-based, prospective, longitudinal one-year outcomes registry (lumbar spine module) was introduced into neurosurgery and orthopedic spine practices. Baseline, peri-operative, 3- and 12-month medical record and patient-reported outcomes data was entered prospectively into the REDCapTM web-based portal. Figure 1. For quality control and validation, automated missing data reports were communicated to sites weekly, targeted site education was instituted when needed, and 10% of sites audited.

Results: Registry characteristics at 11 mos: 33 practice-groups; 175 surgeons; 47 hospitals in 24 states. 3550 patients were enrolled (1857 at 3 month f/u). Cumulative missing data was <2% (of > 400,000 independent variables). Three-month loss to follow-up: 9%. Site audits demonstrated data extraction accurate in all (56/56) cases; patient inclusion accurate in 97%. Surgical morbidity given in Table 1. Significant improvement in pain, disability, and quality of life was reported by patients three months post-operatively, however, marked variation in outcome was observed at the individual patient level(Figures 2&3). Risk-adjusted expected benchmarks for safety and effectiveness varied significantly between sites based on their unique patient populations(Figures 4&5).

Conclusions: A prospective, nationwide, outcomes registry is feasible with high degree of data integrity. Early results suggest that the safety and effectiveness of surgical spine care cannot be accurately measured in the real world setting without robust risk adjustment of disease-specific clinical variables. The N2QOD registry platform generates accurate evidence for informed decision support for patients, surgeons, and policy makers.

Patient Care: This research will improve patient care by allowing for the determination robust, risk-adjusted outcomes of care that will be used by practitioners to promote quality and safety in spine surgery

Learning Objectives: By the conclusion of this session, participants should be able to 1) Describe the importance of clinical registries in promoting healthcare quality, safety and efficiency 2) Understand the importance of risk-adjusted outcomes measures in reporting quality data and interpreting variations in observed clinical outcomes 3) Discuss various methods for developing comprehensive outcomes programs relevant to spine care

References: 1. Asher, A., Kondziolka, D., McCormick, P. The Science of Practice: Addressing the Challenges of Modern Healthcare Neurosurg Focus. 2013, Jan; 34 (1): Introduction, 1-3 2. McGirt, M., Speroff, T., Dittus, R., Harrell, F. and Asher, A. The National Neurosurgery Quality and Outcomes Database (N2QOD): General Overview and Pilot Year Project Description. Neurosurg Focus. 2013, Jan; 34 (1): E6, 1-10