The Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP)

Lee, Michael J.; Shonnard, Neal; Farrokhi, Farrokh; Martz, Dean; Baker, R D; Hsiang, John; Lee, Chong; Gholish, Ray; Flum, David R.

doi:10.1097/brs.0000000000000750

Cited by 15 publications

(11 citation statements)

References 27 publications

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“…The impact of baseline functional status on postoperative outcomes following lumbar spine surgery is a consistent finding in the literature. 11,12,19,28,[36][37][38]44,46,48,65 Analogous to our results, numerous previous studies have demonstrated that the patients whose baseline disability, pain, and QOL scores are, on average, worse than those of others are more likely to have poorer outcomes at 12 months. 3,14,48 Conversely, we found that patients with higher baseline NRS-LP scores had greater odds of having better outcomes.…”

Section: Predictors Of Outcomesupporting

confidence: 85%

An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

McGirt

Bydon

Archer

et al. 2017

Journal of Neurosurgery: Spine

142

150

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OBJECTIVEQuality and outcomes registry platforms lie at the center of many emerging evidence-driven reform models. Specifically, clinical registry data are progressively informing health care decision-making. In this analysis, the authors used data from a national prospective outcomes registry (the Quality Outcomes Database) to develop a predictive model for 12-month postoperative pain, disability, and quality of life (QOL) in patients undergoing elective lumbar spine surgery.METHODSIncluded in this analysis were 7618 patients who had completed 12 months of follow-up. The authors prospectively assessed baseline and 12-month patient-reported outcomes (PROs) via telephone interviews. The PROs assessed were those ascertained using the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for back pain (BP) and leg pain (LP). Variables analyzed for the predictive model included age, gender, body mass index, race, education level, history of prior surgery, smoking status, comorbid conditions, American Society of Anesthesiologists (ASA) score, symptom duration, indication for surgery, number of levels surgically treated, history of fusion surgery, surgical approach, receipt of workers’ compensation, liability insurance, insurance status, and ambulatory ability. To create a predictive model, each 12-month PRO was treated as an ordinal dependent variable and a separate proportional-odds ordinal logistic regression model was fitted for each PRO.RESULTSThere was a significant improvement in all PROs (p < 0.0001) at 12 months following lumbar spine surgery. The most important predictors of overall disability, QOL, and pain outcomes following lumbar spine surgery were employment status, baseline NRS-BP scores, psychological distress, baseline ODI scores, level of education, workers’ compensation status, symptom duration, race, baseline NRS-LP scores, ASA score, age, predominant symptom, smoking status, and insurance status. The prediction discrimination of the 4 separate novel predictive models was good, with a c-index of 0.69 for ODI, 0.69 for EQ-5D, 0.67 for NRS-BP, and 0.64 for NRS-LP (i.e., good concordance between predicted outcomes and observed outcomes).CONCLUSIONSThis study found that preoperative patient-specific factors derived from a prospective national outcomes registry significantly influence PRO measures of treatment effectiveness at 12 months after lumbar surgery. Novel predictive models constructed with these data hold the potential to improve surgical effectiveness and the overall value of spine surgery by optimizing patient selection and identifying important modifiable factors before a surgery even takes place. Furthermore, these models can advance patient-focused care when used as shared decision-making tools during preoperative patient counseling.

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Section: Predictors Of Outcomesupporting

confidence: 85%

An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

McGirt

Bydon

Archer

et al. 2017

Journal of Neurosurgery: Spine

142

150

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“…A team of experts from four leading orthopedic registries that collect PROMs (FORCE-TJR, CERTAIN, the Kaiser Permanente Total Joint Registry and the California Joint Replacement Registry) [19202122], together with diverse stakeholders (clinicians, patients, electronic medical record vendors, hospital administrators, health services and outcomes researchers, and policymakers), identified generalizable PROM implementation lessons. These lessons informed a framework and toolkit of promising strategies to accelerate collection and use of PROMs in health care.…”

Section: Methodsmentioning

confidence: 99%

Framework To Guide The Collection And Use Of Patient-Reported Outcome Measures In The Learning Healthcare System

Franklin

Chenok²,

Lavalee

et al. 2017

eGEMs

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Background:Web-based collection of patient-reported outcome measures (PROMs) in clinical practice is expanding rapidly as electronic health records include web portals for patients to report standardized assessments of their symptoms. As the value of PROMs in patient care expands, a framework to guide the implementation planning, collection, and use of PROs to serve multiple goals and stakeholders is needed.Methods:We identified diverse clinical, quality, and research settings where PROMs have been successfully integrated into care and routinely collected and analyzed drivers of successful implementation. Findings are based on key informant interviews with 46 individuals representing 38 organizations, of whom 40 participated in a webinars series, and 25 attended an in-person workshop designed to enable broad stakeholder input, review and refinement of the proposed PROMs implementation model. Stakeholders identified differing uses of PROMs to support: 1) individual patient care decisions, 2) quality improvement initiatives, 3) payer mandates, and 4) population health and research.Results:The implementation framework and steps that are consistently identified by stakeholders as best practices to guide PROM capture and use are described. Of note, participants indicate that web-based informatics tools are necessary but not sufficient for PROM use, suggesting that successful PROM implementation requires integration into clinic operations and careful planning for user’s analytic needs. Each of the four identified uses may require implementation modifications at each step to assure optimal use.Conclusions:The proposed framework will guide future PROM implementation efforts across learning health care systems to assure that complete PROMs are captured at the correct time, and with associated risk factors, to generate meaningful information to serve diverse stakeholders.

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“…Many Washington State hospitals participate in a novel data surveillance and benchmarking network called the Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP), a quality improvement and benchmarking collaborative [20]. Participation in Spine SCOAP is voluntary, but approximately 75% of eligible spinal procedures in Washington State take place within the Spine SCOAP network.…”

Section: Methodsmentioning

confidence: 99%

Intra-Wound Antibiotics and Infection in Spine Fusion Surgery: A Report from Washington State's SCOAP-CERTAIN Collaborative

Ehlers

Khor

Shonnard

et al. 2016

Surgical Infections

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Background: Surgical site infection (SSI) after spine surgery is classified as a ''never event'' by the Centers for Medicare and Medicaid. Intra-wound antibiotics (IWA) have been proposed to reduce the incidence of SSI, but robust evidence to support its use is lacking. Methods: Prospective cohort undergoing spine fusion at 20 Washington State hospitals ( July 2011 to March 2014) participating in the Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP) linked to a discharge tracking system. Patient, hospital, and operative factors associated with SSI and IWA use during index hospitalizations through 600 days were analyzed using a random effects logistic model (index), and a time-to-event analysis (follow-up) using Cox proportional hazards. Results: A total of 9,823 patients underwent cervical (47%) or lumbar (53%) procedures (mean age, 58; 54% female) with an SSI rate of 1.1% during index hospitalization. Those with SSI were older, more often had diabetes mellitus, and more frequently underwent lumbar (versus cervical) fusion compared with those without SSI (all p < 0.01). Unadjusted rates of SSI during index hospitalization were lower in patients who received IWA (0.8% versus 1.5%). After adjustment for patient, hospital, and operative factors, no benefit was observed in those receiving IWA (odds ratio [OR] 0.65, 95% confidence interval [CI]: 0.42-1.03). At 12 mo, unadjusted rates of SSI were 2.4% and 3.0% for those who did and did not receive antibiotics; after adjustment there was no significant difference (hazard ratio [HR] 0.94, 95% CI: 0.62-1.42). Conclusions: Whereas unadjusted analyses indicate a nearly 50% reduction in index SSI using IWA, we did not observe a statistically significant difference after adjustment. Despite its size, this study is underpowered to detect small but potentially relevant improvements in rates of SSI. It remains to be determined if IWA should be promoted as a quality improvement intervention. Concerns related to bias in the use of IWA suggest the benefit of a randomized trial.

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The Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP)

Abstract: 2.

Cited by 15 publications

References 27 publications

An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

Framework To Guide The Collection And Use Of Patient-Reported Outcome Measures In The Learning Healthcare System

Intra-Wound Antibiotics and Infection in Spine Fusion Surgery: A Report from Washington State's SCOAP-CERTAIN Collaborative

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