Prospective spine care registries: The next frontier?

Written by Laura Dyrda | November 10, 2014 | Print  |

Gathering data is critically important in today's healthcare environment, and many surgeons are part of health systems that do so. They gather some data at their practices or surgery centers and analyze the numbers for better results.

But what about prospective spine care registries? What role will they play in the spine arena going forward?


A special edition of the journal Spine examines just that. In one of the articles, leaders from the Vanderbilt Medical Center Department of Orthopedic & Neurosurgery attempted to review existing spine surgery registries and describe the Vanderbilt Prospective Spine Registry for the impact on research, value analysis, quality improvement and practice-based learning.


There were 13 existing spine registries examined in the study, with only two starting before 2000 and three more added between 2001 and 2005. The follow-up rates were 22 percent to 79 percent with longer follow-up times producing lower follow-up rates. The registries could be powerful tools for cost, safety and effectiveness to show the real value of an episode of care, concluded the study authors.


Some of the registries are based on claims or billing data, which can be helpful but don't provide comprehensive data to drive patient-centered reform. Instead, the researchers recommended prospective registries include:


•    Clear eligibility for enrollment
•    Careful patient grouping by disease and treatment
•    Longitudinal collection of patient-reported outcomes
•    Missing covariate data
•    Follow-up rates of major endpoints should be transparent and minimized
•    Quality control measures to ensure data validity


There were also a few concerns the article authors raised, including high costs associated with gathering clinical registry data — which is significantly less than randomized controlled trial data. The costs are still a barrier, with the National Neurosurgery Quality and Outcomes Database and Swedish Spine as the only multicenter, clinical spine surgery registries "collecting prospective, longitudinal patient-reported outcomes with a 12-month follow-up rate more than 75 percent."


However, there could be additional registries formed in the future.


"As more spine-focused registries emerge and their integration into the U.S. and international healthcare delivery evolve, the evidence to power value-based reform will be enabled," the study authors concluded.


Here are three key trends to watch for in the future:


1. Healthcare providers wishing to "bend the cost curve" and achieve sustainable healthcare will use the highest quality and most effective medical and surgical treatments.


2. More providers will be held accountable for the equality and cost of healthcare, with value-based purchasing as a huge incentive in the resource-restricted medical economy.


3. The traditional randomized clinical trials that are high level and highly focused don't account for individual variations in patients and healthcare settings whereas prospective, longitudinal, patient-reported outcomes registries can measure patients effectively across the episode of care.


More articles on spine surgery:
Where spine device companies stand in 3Q—76 things to know
SI joint fusion could explode by 2020—5 things to know
8 key trends in the U.S. minimally invasive spine technology market

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