title: The National Neurosurgery Quality and Outcomes Database (N2QOD): a collaborative North American outcomes registry to advance value-based spine care.
abstract: METHODS
  National Prospective Observational Registry.
  
  
  OBJECTIVE
  Describe our preliminary experience with the National Neurosurgery Quality and Outcomes Database (NQOD), a national collaborative registry of quality and outcomes reporting after low back surgery.
  
  
  BACKGROUND
  All major health care stakeholders are now requiring objective data regarding the value of medical services. Surgical therapies for spinal disorders have faced particular scrutiny in recent value-based discussions, in large part due to the dramatic growth in the cost and application of these procedures. Reliable data are fundamental to understanding the value of delivered health care. Clinical registries are increasingly used to provide such data.
  
  
  METHODS
  The NQOD is a prospective observational registry designed to establish risk-adjusted expected morbidity and 1-year outcomes for the most common lumbar surgical procedures performed by spine surgeons; provide practice groups and hospitals immediate infrastructure for analyzing their 30-day morbidity and mortality and 3- and 12-month quality data in real-time; generate surgeon-, practice-, and specialty-specific quality and efficacy data; and generate nationwide quality and effectiveness data on specific surgical treatments.
  
  
  RESULTS
  In its first 2 years of operation, the NQOD has proven to be a robust data collection platform that has helped demonstrate the objective quality of surgical interventions for medically refractory disorders of the lumbar spine. Lumbar spine surgery was found to be safe and effective at the group mean level in routine practice. Subgroups of patients did not report improvement using validated outcome measures. Substantial variation in treatment response was observed among individual patients.
  
  
  CONCLUSIONS
  The NQOD is now positioned to determine the combined contribution of patient variables to specific clinical and patient-reported outcomes. These analyses will ultimately facilitate shared decision making and encourage efficient allocation of health care resources, thus significantly advancing the value paradigm in spine care.
  
  
  METHODS
  3.
authors.affiliation: *Carolina Neurosurgery and Spine Associates and the Carolinas Healthcare System Neuroscience Institute, Charlotte, NC †Vanderbilt Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN ‡Department of Medicine, Vanderbilt University School of Medicine and Veterans Affairs Tennessee Valley Healthcare System, Nashville §Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN ¶Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN ∥Department of Neurological Surgery, University of California San Francisco **Department of Neurological Surgery, Oregon Health & Science University, Portland ††Department of Orthopedic Surgery, University of Louisville and the Norton Leatherman Spine Center, Louisville, KY ‡‡Department of Neurosurgery, University of Virginia Medical School, Charlottesville; and §§Semmes-Murphey Neurologic and Spine Institute, Memphis, TN.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Asher
authors.forename: Ted
authors.initials: T
authors.lastname: Speroff
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Jason M
authors.initials: JM
authors.lastname: Davies
authors.forename: Nathan
authors.initials: N
authors.lastname: Selden
authors.forename: Hui
authors.initials: H
authors.lastname: Nian
authors.forename: Steven
authors.initials: S
authors.lastname: Glassman
authors.forename: Praveen
authors.initials: P
authors.lastname: Mummaneni
authors.forename: Christopher
authors.initials: C
authors.lastname: Shaffrey
authors.forename: Clarence
authors.initials: C
authors.lastname: Watridge
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009656:North America; D061214:Patient Safety; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life; D012042:Registries / Q000592:standards / Q000706:statistics & numerical data; D013122:Spinal Diseases / Q000150:complications / Q000191:economics* / Q000601:surgery*; D016896:Treatment Outcome