Performance Indicators in Spine Surgery

STUDY DESIGN:Systematic Review OBJECTIVE:Elucidate how performance indicators are currently used in spine surgery SUMMARY OF BACKGROUND DATA:The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators. METHODS:MEDLINE, CINAHL Plus, EMBASE and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016.All full text manuscripts were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the 3 criteria of established standard, exclusion/risk adjustment and benchmarking to determine if it constituted a performance indicator. RESULTS:The initial search yielded 85 results among which 2 relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided 5 additional reports which in turn led to 6 additional articles. A total of 27 full text articles and reports were retrieved and reviewed.We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken in orderto craft the first performance indicator in spine surgery. CONCLUSION:The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but require benchmarking to truly measure performance.Level of Evidence:1