Building and implementing an institutional registry for a data-driven national neurosurgical practice: experience from a multisite medical center.

In an era when healthcare "value" remains a much-emphasized concept, measuring and reporting the quality of neurosurgical care and costs remains a challenge for large multisite health systems. Ensuring cohesion in outcomes across multiple sites is important to the development of a holistic competitive marketing strategy that seeks to promote "brand" performance characterized by a superior quality of patient care. This requires mechanisms for data collection and development of a single uniform outcomes measurement system site wide. Operationalizing a true multidisciplinary effort in this space requires intersection of a vast array of information technology and administrative resources along with the neurosurgeons who provide subject-matter expertise relevant to patient care. To measure neurosurgical quality and safety as well as improve payor contract negotiations, a practice analytics dashboard was created to allow summary visualization of operational indicators such as case volumes, quality outcomes, and relative value units and financial indicators such as total hospital costs and charges in order to provide a comprehensive overview of the "value" of surgical care. The current version of the dashboard summarizes these metrics by site, surgeon, and procedure for nearly 30,000 neurosurgical procedures that have been logged into the Mayo Clinic Enterprise Neurosurgery Registry since transition to the Epic electronic health record (EHR) system. In this article, the authors sought to review their experience in launching this EHR-linked data-driven neurosurgical practice initiative across a large, national multisite academic medical center.

Team-Based Approach to Successful Annual Wellness Visits.

OBJECTIVE: The purpose of this study was to implement a 2-phase approach to rapidly increase the number of annual wellness visits (AWVs) and build a sustainable model at 3 study units (Mayo Clinic in Rochester, Minnesota, and clinics in 2 regions of Mayo Clinic Health System), which collectively serve approximately 80 000 patients who qualify for an AWV annually. METHODS: In the rapid improvement phase, beginning in July 2022, goals at the facilities were reoriented to prioritize AWVs, educate staff on existing AWV resources, and create low-effort workflows so that AWVs could be incorporated into existing patient appointments. Staff at all 3 study units worked independently and iterated quickly. In the second phase, all study units collaborated to design and implement a best-practice solution while they leveraged the engagement and lessons learned from the first phase and invested in additional system elements and change management to codify long-term success. RESULTS: The number of AWVs completed monthly increased in each study unit. In the rapid improvement phase, the number of AWVs increased but then plateaued (or decreased at some study units). In April 2023, the final scheduled outreach automation and visit tools were implemented, and the number of AWVs was sustained or increased, while outreach and scheduling times were decreased. The number of completed AWVs increased from 1148 across all study units in the first 6 months of 2022 to 14 061 during the first 6 months of 2023. CONCLUSIONS: The lessons learned from this project can be applied to other health systems that want to provide more patients with AWVs while improving operational efficiency. The keys are to have a clear vision of a successful outcome, engage all stakeholders, and iterate quickly to find what works best for the organization.

Mental illnesses among patients undergoing elective anterior cervical discectomy and fusion: Analysis from the National Readmissions Database.

OBJECTIVE: Patients with a comorbid mental illness have been observed to have worse outcomes following surgery. However, little is known about the effects of mental disorders on patient outcomes following spinal surgery. In the current study, we sought to investigate the characteristics of patients with mental illness, particularly anxiety, major depressive disorder, concurrent anxiety and schizophrenia, and the impact of these comorbid conditions on outcomes of patients undergoing anterior cervical discectomy and fusion (ACDF) using a national administrative database. PATIENTS AND METHODS: The National Readmissions Database (NRD) was queried for patients undergoing an ACDF between 2012 and September 30th, 2015. The presence of anxiety, major depressive disorder, concurrent anxiety and schizophrenia were captured using International Classification of Diseases, Ninth Revision (ICD-9) codes. Multivariable logistic regression was used to establish an association between a mental comorbidity and risk of 30- and 90- day readmission. RESULTS: A total of 139,877 patients undergoing elective ACDF between 2012-2015 were identified, of which 15,927 (11.39 %) had anxiety, 514 (0.38 %) had major depressive disorder, 248 (0.18 %) had concurrent anxiety and major depressive disorder, and 287 (0.21 %) had schizophrenia. Upon multivariable analysis of procedural related readmissions, adjusting for an array of patient and hospital related factors, patients with schizophrenia, compared to controls, had a significantly higher risk of 30-day readmission (OR 2.62, 95 %CI 1.42-4.84, p = 0.002); moreover, schizophrenia (OR = 1.92, 95 % CI 1.13-3.25, p = 0.016) anxiety (OR = 1.13, 95 %CI 1.02-1.26, p = 0.023) were also associated with significantly higher risk of 90-day readmission. CONCLUSION: Our analysis indicates that mental illness comorbidities may be associated with increased rates of procedure related readmission and longer length of stay following elective ACDF.