Goal of data on spine procedures in Washington is to improve statewide care

Information in the spine Surgical Care and Outcomes Assessment Program has been important for hospital quality improvement in the state.

SAN FRANCISCO — Twenty hospitals in Washington state participate in a voluntary collaborative effort to collect prospective data on consecutive spine surgery cases. The data are organized by the spine Surgical Care and Outcomes Assessment Program, which began in 2011.

Dean R. Martz, MD, said in a presentation at the American Association of Neurological Surgeons Annual Meeting the information collected in the database presents an opportunity for quality improvement at hospitals and for spine surgery patients in Washington state.

“The goal is to use this information to try and improve things,” he said.

Gathering statewide information

According to Martz, the database showed 4,087 lumbar procedures and 2,273 cervical procedures were performed among 6,407 patients (mean age 57.7 years) who underwent spine surgery at 20 spine Surgical Care and Outcomes Assessment Program (SCOAP) hospitals from August 2011 through December 2012.

At the time of surgery, 38% of patients were working, 8.2% of patients were disabled and 17% of patients were unemployed. Stenosis and spinal instability indications were most common, in 72.5% and 41.9% of cases, respectively.

To date, the database contains clinical data on about 80% of spinal surgeries performed throughout the state. The data extraction is done by hospital staff and employees of the Foundation for Health Care Quality, Martz explained. The abstracted data is provided back to member surgeons and hospitals on a quarterly basis.

“We also gathered information on potential modifiable risk factors, and the goal here is, by sharing this information back to our colleagues throughout the state, to begin a dialogue that will ultimately lead to less people having these risk factors when they come in for their surgery,” Martz said.

For example, surgeons now pay closer attention to preoperative use of opioids in some patients scheduled for spinal surgery.

The database is funded through annual hospital fees paid to the Foundation for Health Care Quality, which is a sponsor for SCOAP, according to Neal H. Shonnard, MD, director of Spine SCOAP. Hospitals cover abstraction costs and research grant funding is used to develop exploratory metrics, he noted.

Spine SCOAP efforts

“The first experience with this was in 2009 when the Foundation working with the hospital association was able to achieve 100% compliance with the surgical checklist across the state,” Martz said. “Current efforts that are suggested in the program include smoking cessation, reducing use of opioids preoperatively, better management of diabetes, and preoperative assessment of nutrition in patients.”

Martz explained hospital staff and employees of the Foundation for Health Care Quality perform the data extraction and collection.

In addition to acquiring initial information, the staff and employees follow-up with those who have a procedure after 6 months and 12 months to obtain patient reported outcomes, as well as information on return to work and any complications they have experienced, he said.

Using data to improve outcomes

“Preoperatively, we gathered information on a broad range of demographics in clinical data points, including incidence of prior surgery, use of selective medications, comorbidities and insurance types,” Martz said.

The program tracks the use of other interventions, such as an intubation during a hospital stay or an esophageal injury, and a patient’s final discharge status.

“It was a great experience to put this together, but the real focus is to begin to use this information to improve the level of care in the state as a whole,” Martz said at the meeting. – by Robert Linnehan

Reference:

Martz DR. Paper #709. Presented at: American Association of Neurological Surgeons Annual Meeting; April 5-9, 2014; San Francisco.

For more information:

Dean R. Martz, MD, can be reached at Inland Neurosurgery and Spine Associates Spokane, 105 W. 8th Ave., Suite 200, Spokane, WA 99204; email: dmartz@neuroandspine.com.

Neal H. Shonnard, MD, can be reached at the Rainier Orthopedic Institute, 3801 5th St. SE, Suite 110, Puyallup, WA 98374; email: n.shonnard@proliancesurgeons.com.

Disclosures: Martz and Shonnard have no relevant financial disclosures.