What is the driving force behind medical progress? Some would say it’s more advanced technology, and they wouldn’t be wrong. However, I believe the fastest path to optimization, especially in the field of spine surgery, is better data. The more we study patient outcomes to see what works and what doesn’t, the better we will be able to establish universal best practices in a field filled with heterogeneous results. That is exactly what Dr. Steven Glassman hopes to accomplish with the American Spine Registry.
Bridging the information gap
Before the advent of the internet and digital record keeping, the general availability of medical outcome data was sparse. Earlier in his career, Dr. Steven Glassman had the opportunity to present data in favor of spine surgery to the Centers for Medicare & Medicaid Services (CMS). The problem was that all of his data came from specialty centers and couldn’t definitively show that his outcomes were repeatable in a standard clinical practice. This was the first time Dr. Glassman saw the value of using registry data to inform research.
Most medical research is done through what is known as randomized control trials (RCT) using the scientific method. These trials produce the highest quality of data and allow researchers to answer specific questions about their field. However, when it comes to answering broader and more universal questions, RCTs are painstakingly slow. Most papers based on RCTs refer to procedures and trials that took place years before publication. The data simply doesn’t keep up with the need for information. This is the real value of a registry: speed! They can rapidly give broader data that looks at standard clinical practice which allows for quality assurance and quality improvement that you’re not likely to get out of RCTs effectively.
Building progress
So what kinds of data make up the ASR? The initial information uploaded into the ASR is patient demographics, CPT data, diagnostic data, comorbidity data, readmissions, reoperations, complications…anything that can be found in electronic medical records (EMR). Establishing the EMR pipeline has been critical to the development of the ASR because it provides the unique identifiers that help build the granularity of the database. The other half of the ASR is patient-based outcomes data with a baseline of three months, six months, and one year.
Right now, the ASR has 75,000 new patients in its registry. That’s an impressive feat for a system that has only been active for two years and collecting data for at most 8 months. The next step is integrating that database with the 100,000 patients currently on the Quality Outcomes Database (QOD). However, Dr. Glassman’s goal is to collect as much patient-based outcomes data as possible. Beyond existing databases, he hopes that the ASR will become a standard method for spine patient data collection that propels spine surgery research forward.