Tracking outcomes is a top priority for spine surgeons. The neurosurgical community has continued to push for the collection of outcomes through a national data registry formerly known as the National Neurosurgery Quality and Outcomes Database (N²QOD). It’s now referred to as the Quality Outcomes Database (QOD).
The QOD (which has no formal relationship with CODE) has a primary purpose of tracking the quality of surgical care of frequent neurosurgical procedures. As outlined on its website, the QOD also provides hospitals and private practices with an “immediate infrastructure for analyzing and reporting the quality of their neurosurgical care.”
This registry also allows for pooled data analysis and benchmarking, which adds to the appeal of providers electing to participate. It also has established data collection modules which use PRO tools. This includes the patient-population specific Oswestry Disability Index (ODI) and general health EQ-5D PRO tools for a number of common spine conditions including lumbar and cervical spine, deformities, and tumors.
In 2015, as a part of the CMS Physician Quality Reporting System, QOD was approved as a Qualified Clinical Data Registry (QCDR).
The methodology of QOD is solid and rigorous. In efforts to ensure data integrity and a minimum of 80% capture rate for 1-year outcome data, the number of patients enrolled is restricted to six per week. Potential participants are identified from the weekly-posted Operating Room schedule, and the first six who meet the criteria are enrolled. At the end of the of the six-day period, an additional six patients meeting the criteria are enrolled in the next six-day period.
To participate in QOD, a group must apply to the managing group for the N²QOD called NeuroPoint Alliance (NPA). Contact NPA at info@NeuroPoint.org or 847-378-0549 with a request to participate in QOD.
Once the application has been received and approved the group is responsible for completing and gaining IRB approval for their institution to be designated as a non-research, clinical quality improvement effort, thereby exempting them from IRB review and the requirement for informed consent.
In addition to obtaining IRB approval, each practice must hire a designated Data Coordinator. It is estimated that the Data Coordinator position will require a 0.5 FTE or a commitment of approximately 20 hours a week. An additional Data Coordinator is required for each module the group elects to participate in.
The QOD has done an amazing job of mobilizing a very large group of neurosurgeons to start collecting data from across the country for pooled analysis and benchmarking.
However, there are several challenges associated with this system. The first is the feasibility of hiring a Data Coordinator. While the requirements only require a part-time employee, the additional cost is a barrier for some groups that wish to participate.
The other component of the program that raises questions is the enrollment restrictions. For a large group of providers, limiting the number of patients enrolled to six per week only represents a small sample size of their total patient population. The QOD has yet to find a method other than restricting the number of patients who are enrolled that ensures a high 1-year data capture rate.
**CODE has no formal relationship with QOD. Because CODE clients own the data collected, any hospital utilizing CODE’s PRO Solution for data collection can submit their data to QOD.