Nov. 25, 2021
Mayo Clinic has developed a novel neurosurgical registry that tracks surgical outcomes and cost data across the enterprise. In the new era of medical reform, Mayo Clinic's neurosurgical registry offers a model for standardizing outcomes and tracking value in large health care centers.
"Our registry provides hard data on quality, costs, volumes and outcomes. It is helping us to transform our practice," says Mohamad Bydon, M.D., a neurosurgeon at Mayo Clinic in Rochester, Minnesota.
The registry links data from patients' electronic health records (EHRs) to a practice analytics dashboard. The dashboard allows summary visualization of both surgical and financial indicators to provide a comprehensive overview of the value of neurosurgical care. That overview helps measure neurosurgical quality and safety and can improve payer contract negotiations.
"Large health care systems need to move in the direction of value-based medicine. That requires providers to demonstrate the quality and efficiency of their practices," Dr. Bydon says.
The neurosurgical registry summarizes metrics by site, surgeon and procedure for the nearly 20,000 neurosurgeries performed at Mayo Clinic since 2018, when the enterprise adopted a new EHR system. One of the world's largest multispecialty practices, Mayo Clinic performs neurosurgery at its three main campuses — in Arizona, Florida and Minnesota — as well as at the Mayo Clinic Health Care System sites in Mankato, Minnesota, and Eau Claire and La Crosse, Wisconsin.
"Registries represent sustainable solutions for characterizing real-world surgical care while identifying large-scale improvement opportunities," Dr. Bydon says. "Registries may also represent a viable tool to stipulate quality of care to purchasers of health care services."
A leader in data-driven medicine
Mayo Clinic has long been at the forefront of patient registries and data-driven medicine. The concept of a single unified patient medical record originated with Dr. Henry S. Plummer, who was hired in 1901 by the founding Mayo brothers.
"Dr. Plummer's concept was one of the first applications of clinical data mining that would mark a natural transition to the era of EHRs and big data that we know today," Dr. Bydon says.
In an article to be published in Neurosurgical Focus — and in a September 2021 article in Harvard Business Review — Mayo Clinic neurosurgeons describe how the new neurosurgical registry was developed.
The key metrics used to evaluate neurosurgical performance include case volumes, surgical complications and hospital readmissions. The cost-related metrics are Relative Value Units — the cost calculations used by Medicare to determine reimbursement to providers — and average total cost of surgical admission. Validated patient-reported outcomes measures also are included.
In addition to descriptive analytics, a predictive analytics component was created. A point-of-care neurosurgical risk calculator identifies the potential major complications associated with a particular patient profile. The calculator is currently used for brain tumor resections and spinal fusions — the most common neurosurgeries at Mayo Clinic — but is expected to be used for additional procedures.
"Our predictive analytics can set more realistic expectations for patients," Dr. Bydon says. "Typically, predictive models are trained using data captured in registries from several different institutions and often different geographic settings and types of practice. Our risk calculator is based on real-time evidence from our practice."
The registry has facilitated multisite discussions identifying possible areas for quality improvement to standardize surgical performance.
"The initiative has also helped to improve payer contract negotiations," Dr. Bydon says. "These negotiations increasingly involve requests for outcome data. We can easily meet those requests and demonstrate clinical quality in a reliable fashion."
He notes that clinical registries are valuable but often underused assets for health care centers. "At Mayo Clinic, we envisioned a system that would display select patient information through dashboards — a tool to provide a comprehensive overview of a clinic's performance," Dr. Bydon says. "Mayo Clinic Neurologic Surgery has created that tool for our expanding practice."
For more information
Bydon M, et al. Building and implementing an institutional registry for a data-driven national neurosurgical practice: Experience from a multi-site medical center. Neurosurgical Focus. In press.
Bydon M, et al. Lessons from the Mayo Clinic on using data to improve surgical outcomes. Harvard Business Review.