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首页> 外文期刊>Neurosurgical focus >The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative
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The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative

机译：密歇根脊柱手术改善协作：全国范围的协作质量倡议

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OBJECT Given the scrutiny of spine surgery by policy makers, spine surgeons are motivated to demonstrate and improve outcomes, by determining which patients will and will not benefit from surgery, and to reduce costs, often by reducing complications. Insurers are similarly motivated. In 2013, Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) established the Michigan Spine Surgery Improvement Collaborative (MSSIC) as a Collaborative Quality Initiative (CQI). MSSIC is one of the newest of 21 other CQIs that have significantly improved—and continue to improve—the quality of patient care throughout the state of Michigan. METHODS MSSIC focuses on lumbar and cervical spine surgery, specifically indications such as stenosis, disk herniation, and degenerative disease. Surgery for tumors, traumatic fractures, deformity, scoliosis, and acute spinal cord injury are currently not within the scope of MSSIC. Starting in 2014, MSSIC consisted of 7 hospitals and in 2015 included another 15 hospitals, for a total of 22 hospitals statewide. A standardized data set is obtained by data abstractors, who are funded by BCBSM/BCN. Variables of interest include indications for surgery, baseline patient-reported outcome measures, and medical history. These are obtained within 30 days of surgery. Outcome instruments used include the EQ-5D general health state score (0 being worst and 100 being the best health one can imagine) and EQ-5D-3 L. For patients undergoing lumbar surgery, a 0 to 10 numeric rating scale for leg and back pain and the Oswestry Disability Index for back pain are collected. For patients undergoing cervical surgery, a 0 to 10 numeric rating scale for arm and neck pain, Neck Disability Index, and the modified Japanese Orthopaedic Association score are collected. Surgical details, postoperative hospital course, and patient-reported outcome measures are collected at 90-day, 1-year, and 2-year intervals. RESULTS As of July 1, 2015, a total of 6397 cases have been entered into the registry. This number reflects 4824 eligible cases with confirmed surgery dates. Of these 4824 eligible cases, 3338 cases went beyond the 120-day window and were considered eligible for the extraction of surgical details, 90-day outcomes, and adverse events. Among these 3338 patients, there are a total of 2469 lumbar cases, 862 cervical cases, and 7 combined procedures that were entered into the registry. CONCLUSIONS In addition to functioning as a registry, MSSIC is also meant to be a platform for quality improvement with the potential for future initiatives and best practices to be implemented statewide in order to improve quality and lower costs. With its current rate of recruitment and expansion, MSSIC will provide a robust platform as a regional prospective registry. Its unique funding model, which is supported by BCBSM/BCN, will help ensure its longevity and viability, as has been observed in other CQIs that have been active for several years.
机译：对象鉴于政策制定者的脊柱手术的审查，脊柱外科医生通过确定哪些患者且不会从手术中受益，并通过减少并发症来降低成本来证明和改善结果。保险公司是类似的动机。 2013年，密歇根州（BCBSM）和蓝色护理网络（BCN）的蓝色交叉蓝盾建立了密歇根脊柱手术改善协作（MSSIC）作为合作质量倡议（CQI）。 MSSIC是其他21个其他CQIS之一，它具有显着改善 - 并继续改善 - 在密歇根州的患者护理质量。方法MSSIC侧重于腰椎和颈椎手术，特别是狭窄，椎间盘突出和退行性疾病等适应症。肿瘤的手术，创伤性骨折，畸形，脊柱侧凸和急性脊髓损伤目前不在MSSIC的范围内。从2014年开始，MSSIC由7家医院组成，并于2015年包括其他15家医院，共有22家医院州际全展。标准化的数据集是通过由BCBSM / BCN资助的数据绘图器获得的。感兴趣的变量包括手术的适应症，基线患者报告的结果措施和病史。这些是在手术后30天内获得的。所使用的结果包括EQ-5D一般健康状态得分（0是最差，100是最佳健康，可以想象的最佳健康）和EQ-5D-3 L.对于接受腰椎手术的患者，腿部的0至10个数字评定量表收集背部疼痛和背部疼痛的Oswestry残疾指数。对于接受宫颈手术的患者，收集臂和颈部疼痛，颈部残疾指数的0至10个数字评级规模，以及改性日本矫形关联评分。在90天，1年和2年间隔内收集了手术细节，术后医院课程和患者报告的结果措施。结果截至2015年7月1日，共有6397宗案件已进入登记处。该号码反映了4824条有资格的手术日期的符合条件的案例。在这4824年的符合条件的情况下，3338例超出了120天的窗口，被认为有资格提取手术细节，90天的结果和不良事件。在这3338名患者中，共有2469例腰椎病例，862例宫颈病例和7个综合手续，已进入登记处。结论除了作为登记处的运作之外，MSSIC还意味着能够改进的平台，可能是未来举措和最佳实践的潜力，以提高质量和降低成本。目前的招聘和扩张率，MSSIC将提供一个强大的平台作为区域预期登记处。其独特的资助模式，由BCBSM / BCN提供支持，将有助于确保其寿命和可行性，正如在其他有效期的其他CQIS中所观察到的那样。

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