title: The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative.
abstract: 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.
authors.affiliation: Departments of 1 Neurosurgery.|MSSIC Coordinating Center, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Victor
authors.initials: V
authors.lastname: Chang
authors.affiliation: Departments of 1 Neurosurgery.|Center for Health Policy and Health Services Research; and.|MSSIC Coordinating Center, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Schwalb
authors.affiliation: Departments of 1 Neurosurgery.|Center for Health Policy and Health Services Research; and.|MSSIC Coordinating Center, Henry Ford Hospital, Detroit, Michigan.
authors.forename: David R
authors.initials: DR
authors.lastname: Nerenz
authors.affiliation: Departments of 1 Neurosurgery.|MSSIC Coordinating Center, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Lisa
authors.initials: L
authors.lastname: Pietrantoni
authors.affiliation: Departments of 1 Neurosurgery.|MSSIC Coordinating Center, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Sharon
authors.initials: S
authors.lastname: Jones
authors.affiliation: Public Health Sciences, and.|MSSIC Coordinating Center, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Michelle
authors.initials: M
authors.lastname: Jankowski
authors.affiliation: Public Health Sciences, and.|MSSIC Coordinating Center, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Nancy
authors.initials: N
authors.lastname: Oja-Tebbe
authors.affiliation: Departments of 1 Neurosurgery.|Orthopedics;|MSSIC Coordinating Center, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bartol
authors.affiliation: Departments of 1 Neurosurgery.|MSSIC Coordinating Center, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Muwaffak
authors.initials: M
authors.lastname: Abdulhak
mesh_terms: D003299:Cooperative Behavior; D016208:Databases, Factual / Q000706:statistics & numerical data; D006801:Humans; D008824:Michigan; D009493:Neurosurgery / Q000592:standards; D011446:Prospective Studies; D058996:Quality Improvement; D011788:Quality of Life; D012042:Registries; D013118:Spinal Cord Diseases / Q000601:surgery*; D016896:Treatment Outcome
keywords: BCBSM = Blue Cross Blue Shield of Michigan; BCN = Blue Care Network; CQI = Collaborative Quality Initiative; DVT = deep venous thrombosis; FTE = full-time employee; IRB = institutional review board; MCID = minimum clinically important difference; MSSIC = Michigan Spine Surgery Improvement Collaborative; MUSIC = Michigan Urological Surgery Improvement Collaborative; N2QOD = National Neurosurgery Quality and Outcomes Database; NDI = neck disability index; NRS = numeric rating scale; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QI = quality improvement; RN = registered nurse; mJOA = modified Japanese Orthopaedic Association; prospective database; quality improvement; spine registry