Spine Surgery Outcomes: A Novel Approach to Integrated Patient Outcomes Assessment Targeting a Diverse Prospective Surgical Cohort

Miriam Martha Morales, The University of Texas School of Public Health


The goal of this dissertation was to implement a quality spine surgery registry to collect standardized patient-reported outcomes at standard follow-up intervals with systematic data obtainment methodology, to provide spine surgeons a prospective assessment of changes in patient outcomes. In the spine surgery community, a specific standardized way of assessing long term patient outcomes does not exist. In order to assess outcome measurements appropriately, data would need to be collected using a systematic process and standardized protocols. In 2014, Memorial Hermann Health System launched a quality improvement initiative in neurosurgical care to collect patient reported outcomes through the Mischer Neuroscience Associates (MNA) team and the Mischer Neuroscience Institute. Development of an online patient portal was determined to be the ideal method to streamline an approach to collect patient-reported outcomes. Among elective cervical and lumbar spine surgery patients, the registry goals were to collect standardized patient-reported outcomes at (1) baseline, and (2) 3-month and 6-month follow-up, (3) using electronic data capture tools. Among 1,248 elective spine surgery patients, 81% of our targeted population completed baseline assessments through both paper and electronic data capture. We collected three month follow-up for 17% and six month follow-up for 11% of our targeted population. There were similar distributions of age, gender and ethnicity among patients who completed the registry compared to the overall elective spine surgery population, and among those who completed the registry electronically compared to using paper forms. Among elective spine patients who completed follow-up assessments their outcomes show improvement in quality of life, reduction in pain, and improvement in motor and functional status across several assessment tools, indications for surgery, and procedures performed. While we captured up to 81% of our targeted population, our baseline data capture may have been impacted by low staff adherence to data collection early in the implementation phase. Factors that reduced our ability to collect all three time points fall into two domains: patient- and staff-related. In the patient domain, this includes changes in patient contact information or follow-up outside of the established data collection time periods. In the staff domain, this includes inconsistencies in staff adherence to scheduling follow-up at the baseline visit. As the registry population grows and follow-up capture rates improve we could potentially identify a cohort of patients that would benefit from decompression or laminectomies alone which would improve patient recovery time and reduce health care expenses. This study’s findings will help to develop targeted strategies to improve follow-up rates, support the expansion of the registry to additional sites, and help physicians explore these preliminary results to improve patient pain management and care plans. The expansion of this registry will provide a heterogeneous sample with the capability to collect and assess predictors of patient outcomes combined with patient comorbidities.

Subject Area

Epidemiology|Health care management

Recommended Citation

Morales, Miriam Martha, "Spine Surgery Outcomes: A Novel Approach to Integrated Patient Outcomes Assessment Targeting a Diverse Prospective Surgical Cohort" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10787551.