title: Role of prospective registries in defining the value and effectiveness of spine care.
abstract: METHODS
  Literature review and case example.
  
  
  OBJECTIVE
  Describe methodological considerations of spine surgery registries. Review existing spine surgery registries. Describe the Vanderbilt Prospective Spine Registry (VPSR) as a case example and demonstrate its impact on comparative effectiveness research, value analysis, quality improvement, and practice-based learning.
  
  
  BACKGROUND
  To bend the cost curve and ultimately achieve sustainability in health care, medical providers and surgical treatments of the highest quality and effectiveness must be preferentially used and purchased. As the current US health care environment continues to evolve, it will be essential for all spine clinicians to understand and be facile with the principles of evidence-based health care reform.
  
  
  METHODS
  We describe the methodological considerations of spine surgery registries, review the literature to describe existing spine surgery registries, and discuss the VPSR as a case example.
  
  
  RESULTS
  We were able to obtain detailed information on 13 existing spine surgery registries through various internet-based resources. Of the 13, 2 registries had start dates before 2000, 3 between 2001 and 2005, 5 starting in 2006, and 3 were indeterminate. Follow-up rates were in the range from 22% to 79%, with longer follow-up times consistently producing lower follow-up rates.
  
  
  CONCLUSIONS
  Prospective, longitudinal, patient-reported outcomes registries are powerful tools that allow measurement of cost, safety, effectiveness, and health care value across clinically meaningful episodes of care. Registries entirely based on claims or billing data, safety measures alone, process measures, or other proxies of outcome offer valuable insights, but do not provide comprehensive data to drive patient-centered value-based reform. As more spine-focused registries emerge and their integration into the US health care delivery evolve, the evidence to power value-based reform will be enabled.
authors.affiliation: *Carolina Neurosurgery and Spine Associates, Charlotte, NC †Department of Orthopedic & Neurosurgery, Vanderbilt Medical Center, Nashville, TN; and ‡Spectrum Research Inc., Tacoma, WA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Asher
authors.forename: Dan
authors.initials: D
authors.lastname: Norvell
authors.forename: Ned
authors.initials: N
authors.lastname: Sherry
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
mesh_terms: D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D011787:Quality of Health Care; D012042:Registries / Q000592:standards; D013122:Spinal Diseases / Q000601:surgery*