Closing the loop between evidence-based medicine and care delivery: a possible role for clinical audits in spinal surgery

Dazley, Justin M.; Thomas, D.; Harris, Mitchel B.; Bono, Christopher M.

doi:10.1016/j.spinee.2013.03.055

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Indicators for appropriate study design to identify unwarranted variation and optimal study design to achieve quality improvement were based on previous research and frameworks. 13,14,17,[21][22][23] First, characteristics were extracted to describe whether study design was appropriate to identify unwarranted variation: the level of aggregation, study population (inclusion and exclusion criteria), description and selection of the diagnosis or diagnosis group, and variables used for case-mix correction. Second, characteristics were extracted to describe whether study design was optimal to achieve quality improvement: variation in clinical outcomes, analyzed explanatory variables (other than the variables adjusted for), scientific basis for treatment effectiveness described (i.e., practices compared against clinical guidelines), and if recommendations for clinical practice or future research were given.…”

Section: Data-extractionmentioning

confidence: 99%

“…Public reporting of these studies can be a first step toward change and might close the loop between EBM and clinical practice. 12 , 13 However, analyzing and explaining practice variation is challenging because multiple factors influence variation in surgical rates. 9 Previously, it was described that clinical audits or practice variation research must: 1.…”

Section: Introductionmentioning

confidence: 99%

“…Define warranted and unwarranted use of the target outcome. 13-16 Ideally, the article should investigate the causes of practice variation to identify specific areas for improvement and provide recommendations for clinical practice. 13,17…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16] Ideally, the article should investigate the causes of practice variation to identify specific areas for improvement and provide recommendations for clinical practice. 13,17 We aimed to describe whether practice variation studies on lumbar disc surgery in patients with lumbar degenerative disc disease used adequate study methodology to identify unwarranted variation and to inform quality improvement in clinical practice. Secondary, we were interested whether variation changed over time.…”

Section: Introductionmentioning

confidence: 99%

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Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes

Munster

Weerdt

Halperin

et al. 2021

Global Spine Journal

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Study Design Literature review. Objective To describe whether practice variation studies on surgery in patients with lumbar degenerative disc disease used adequate study methodology to identify unwarranted variation, and to inform quality improvement in clinical practice. Secondary aim was to describe whether variation changed over time. Methods Literature databases were searched up to May 4th, 2021. To define whether study design was appropriate to identify unwarranted variation, we extracted data on level of aggregation, study population, and case-mix correction. To define whether studies were appropriate to achieve quality improvement, data were extracted on outcomes, explanatory variables, description of scientific basis, and given recommendations. Spearman’s rho was used to determine the association between the Extreme Quotient (EQ) and year of publication. Results We identified 34 articles published between 1990 and 2020. Twenty-six articles (76%) defined the diagnosis. Prior surgery cases were excluded or adjusted for in 5 articles (15%). Twenty-three articles (68%) adjusted for case-mix. Variation in outcomes was analyzed in 7 articles (21%). Fourteen articles (41%) identified explanatory variables. Twenty-six articles (76%) described the evidence on effectiveness. Recommendations for clinical practice were given in 9 articles (26%). Extreme Quotients ranged between 1-fold and 15-fold variation and did not show a significant change over time (rho= −.33, P= .09). Conclusions Practice variation research on surgery in patients with degenerative disc disease showed important limitations to identify unwarranted variation and to achieve quality improvement by public reporting. Despite the availability of new evidence, we could not observe a significant decrease in variation over time.

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Section: Data-extractionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes

Munster

Weerdt

Halperin

et al. 2021

Global Spine Journal

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“…Eine weitere Möglichkeit besteht auch in der Auditierung von Wirbelsäulenabteilungen, entweder intern oder extern, um eine Patientenversorgung entsprechend den Leitlinien bzw. der evidenzbasierten Medizin sicherzustellen [25].…”

Section: Register Und Auditierungunclassified

Zukunft der operativen Therapie degenerativer Wirbelsäulenerkrankungen: Kontra – Wandel hin zu weniger Operationen aufgrund fehlender Evidenz

Thomé

2020

Die Wirbelsäule

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ZusammenfassungDer starke Anstieg von Wirbelsäulenoperationen ist Gegenstand der gesundheitspolitischen Diskussion in Deutschland und bietet Anlass zu einer kritischen Analyse. Teilweise ist die rezente Steigerung um 82 % innerhalb von 10 Jahren durch die demographische Entwicklung, das verbesserte perioperative Patientenmanagement und die technische Weiterentwicklung in der spinalen Chirurgie bedingt. Einen größeren Anteil scheinen jedoch systemimmanente Faktoren aufzuweisen. So sind der Einfluss von finanziellen Anreizen, Patientenerwartungen und Chirurgendichte nicht von der Hand zu weisen. Die Operationshäufigkeiten und die vorliegenden Versorgungsdaten aus Deutschland legen nahe, dass die evidenzbasierten Richtlinien nicht verlässlich bzw. nicht flächendeckend eingehalten werden. Bei oftmals fehlender Evidenz für chirurgische Maßnahmen oder für bestimmte Operationstechniken wird eine strengere Indikationsstellung nicht zu umgehen sein, sodass ein Wandel zu weniger Operationen die Folge sein wird. Ob dies durch bereits angestoßene Maßnahmen beispielsweise der Deutschen Wirbelsäulengesellschaft wie Ausbildungsverbesserung, Wirbelsäulenregister oder Zweitmeinungsportale ausreichend erfolgen wird oder durch politische Intervention aufoktroyiert werden muss, wird sich zeigen.

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Comparing National Inpatient Sample and National Surgical Quality Improvement Program

Somani

Capua

Kim

et al. 2017

Spine

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Closing the loop between evidence-based medicine and care delivery: a possible role for clinical audits in spinal surgery

Cited by 6 publications

References 17 publications

Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes

Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes

Zukunft der operativen Therapie degenerativer Wirbelsäulenerkrankungen: Kontra – Wandel hin zu weniger Operationen aufgrund fehlender Evidenz

Comparing National Inpatient Sample and National Surgical Quality Improvement Program

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