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services they provide. With the exception of the CMS’ Physician Quality Reporting Initiative

(PQRI), these efforts are largely fragmented and decentralized among different payors.

By managing a national quality reporting infrastructure, NPA meets the current needs

of neurosurgeons while collecting data that influences the design and selection of future

quality outcome measures.


QOD was designed with a longitudinal structure and includes patient-reported outcomes

(PROs). QOD is the only nationally coordinated registry in the U.S. to measure one-year

effectiveness of care using validated, patient-centered measures. PROs are a key element

in patient-centered care, as they may be more reflective of underlying health status

than physician reporting. The registry contains multiple enrollment variables (patient;

structural; clinical; surgical) and longitudinal quality data focused on PROs for risk


As such, QOD’s design allows for additional meaningful quality improvement efforts that

directly benefit patients. A web-based predictive calculator for registry centers has been

developed for piloting in fiscal year 2017. This tool will facilitate and simplify informed

patient decisions by returning individualized outcome probability graphs demonstrating

and predicting the disability, pain and quality of life outcomes for the patient. Data

analyses include expected benchmarks of care and predictive outcomes derived from the

12-month follow-up data, identifying ways to improve the value of care in spine patients.

Using the predictive calculator, surgeons can enter certain patient characteristics and

the type of procedure to determine whether similar patients benefitted from a particular

treatment. For example, initial QOD results showed that while 85 percent of patients

benefitted from surgery, patients with a high body mass index (BMI), smoking and

diabetes appear to have poorer outcomes after spinal surgery. “If [a patient] can get the

risk factors under control or quit smoking, that would really improve the outcomes of

surgery,” says Robert E. Harbaugh, MD, FAANS.