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  • Measure Summary
  • NQMC:010403
  • Jan 2015

Spinal surgery: average change between lumbar discectomy/laminotomy pre-operative and three months (6 to 20 weeks) post-operative leg pain as measured with the visual analog scale (VAS) for pain.

MN Community Measurement. Data collection guide: spinal surgery: functional status and quality of life outcome measures 2015 (01/01/2013 to 12/31/2013 dates of procedure). Minneapolis (MN): MN Community Measurement; 2015. 132 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the average change between lumbar discectomy/laminotomy pre-operative and three months (6 to 20 weeks) post-operative leg pain as measured with the visual analog scale (VAS) for pain.

Rationale

Overall, spine surgery rates have declined slightly from 2002 to 2007, but the rate of complex spinal fusion procedures has increased 15-fold, from 1.3 to 19.9 per 100,000 Medicare beneficiaries. Complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex spinal fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex spinal fusion compared with decompression alone was 2.95 (95% confidence interval [CI], 2.50 to 3.49) (Deyo et al., 2010). Minnesota, as compared to national Medicare statistics, demonstrates a lumbar spinal fusion rate that is four times the national average (0.84 per 1000 enrollees as compared to 0.2 per 1000) (Center for the Evaluative Clinical Services, 2006). Spinal fusion has become one of medicine's most controversial procedures. Some surgeons argue that spinal fusion is appropriate only for a small number of conditions, such as spinal instability, spinal fracture or severe curvature of the spine and that the financial incentives have caused the procedure to become overused. Others say that it is a useful tool to treat patients who have debilitating back pain and have tried other options like physical therapy to no avail (Carreyrou & McGinty, 2010).

For consumers, there is a lack of publicly reported information that would provide patients with an understanding of potentially how well they will function after having lumbar spinal surgery. These measures will provide outcome data for patients that currently do not exist.

Evidence for Rationale

Carreyrou J, McGinty T. Top spine surgeons reap royalties, Medicare bounty. Wall Str J  2010 Dec 20.

Center for the Evaluative Clinical Services. The Dartmouth Atlas of Health Care: spine surgery. Lebanon (NH): The Dartmouth Institute for Health Policy and Clinical Practice; 2006. 28 p.

Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010 Apr 7;303(13):1259-65. PubMed External Web Site Policy

MN Community Measurement. Data collection guide: spinal surgery: functional status and quality of life outcome measures 2015 (01/01/2013 to 12/31/2013 dates of procedure). Minneapolis (MN): MN Community Measurement; 2015. 132 p.

Primary Health Components

Spinal surgery; lumbar discectomy/laminotomy; leg pain; visual analog scale (VAS)

Denominator Description

Patients who meet each of the following criteria are included in the population:

  • Patients age 18 years and older at the start of the procedure measurement period.
  • Patients who underwent a lumbar discectomy/laminotomy procedure for a diagnosis of disc herniation with a procedure date between January 1 to December 31.
  • Patient had a specific Current Procedural Terminology (CPT) procedure code.
  • Include the patient in the lumbar discectomy/laminotomy population only if the specific CPT procedure code is the only spine procedure code used.
  • Do not include the patient if they have an additional spinal procedure performed.
  • Patient had the following International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code: 722.10.

Numerator Description

The change between pre-operative and three months (6 to 20 weeks) post-operative leg pain for patients who undergo a lumbar discectomy/laminotomy procedure as measured with the visual analog scale (VAS) (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

MN Community Measurement (MNCM) conducts validity testing to determine if quality measures truly measure what they are designed to measure, and conducts reliability testing to determine if measures yield stable, consistent results. Validity testing is done to see if the concept behind the measure reflects the quality of care that is provided to a patient and if the measure, as specified, accurately assesses the intended quality concept. Reliability testing is done to see if calculated performance scores are reproducible.

Evidence for Extent of Measure Testing

MN Community Measurement. Measure testing. [internet]. Minneapolis (MN): MN Community Measurement; [accessed 2015 Nov 12].

State of Use

Current routine use

Current Use

External oversight/State government program

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Case Finding Period

The measurement period (January 1 to December 31)

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Patients who meet each of the following criteria are included in the population:

  • Patients age 18 years and older at the start of the procedure measurement period.
  • Patients who underwent a lumbar discectomy/laminotomy procedure for a diagnosis of disc herniation with the date of procedure between January 1 and December 31.
  • Patient had a specific Current Procedural Terminology (CPT) procedure code (refer to the original measure documentation for specific CPT codes).
  • Include the patient in the lumbar discectomy/laminotomy population only if the specific CPT procedure code is the only spine procedure code used (refer to the original measure documentation for specific CPT codes).
  • Do not include the patient if they have an additional spinal procedure performed (refer to the original measure documentation for specific CPT codes).
  • Patient had the following International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code: 722.10. This diagnosis code can be in any position.

Exclusions
None

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
The change between pre-operative and three months (6 to 20 weeks) post-operative leg pain for patients who undergo a lumbar discectomy/laminotomy procedure as measured with the visual analog scale (VAS)

Note: Visual Analog Pain Scale: A method for assessing the patient's level using a line to assess where the patient is on the continuum of pain. There are numerous pain rating scales in use (public domain).

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Individually Reported Health State

Instruments Used and/or Associated with the Measure

  • Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Measures Flow Chart - Lumbar Discectomy/Laminotomy
  • Visual Analog Scale (VAS)

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Average change between pre-operative and three months (6 to 20 weeks) post-operative leg pain as measured with the visual analog scale (VAS) for pain.

Measure Collection Name

Spinal Surgery

Submitter

MN Community Measurement - Health Care Quality Collaboration

Developer

MN Community Measurement - Health Care Quality Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Jan

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

MN Community Measurement. Data collection guide: spinal surgery: functional status and quality of life outcome measures 2015 (01/01/2013 to 12/31/2013 dates of procedure). Minneapolis (MN): MN Community Measurement; 2015. 132 p.

Measure Availability

Source available from the MN Community Measurement Web site External Web Site Policy.

For more information, contact MN Community Measurement at 3433 Broadway St. NE, Broadway Place East, Suite #455, Minneapolis, MN 55413; Phone: 612-455-2911; Web site: http://mncm.org External Web Site Policy; E-mail: info@mncm.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on December 4, 2015. The information was verified by the measure developer on February 16, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

This measure is subject to review and may be revised or rescinded at any time by MN Community Measurement (MNCM). The measure may not be altered without the prior written approval of MNCM. Measures developed by MNCM, while copyrighted, can be reproduced and distributed without modification for noncommercial purposes (e.g., use by health care providers in connection with their practices). Commercial use is defined as the sale, license, or distribution of the measure for commercial gain, or incorporation of the measure into a product of service that is sold, licensed or distributed for commercial gain. Commercial use of the measure requires a license agreement between the user and MNCM.

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