Q. How did you become interested in the field of quality?

Dr. Gottfried: I had a strong interest in quality outcomes for myself and my group as I started working at Duke University in 2010. I initiated several databases to track and collect our spine group’s patient related outcomes. We collect data internally with multiple databases and contribute to national registries including QOD, NSQIP, and others.

I realized that in order to have the group provide the best possible care, I needed access to real time data and needed the ability to get this data back to the surgeons and group as close to the point of care as possible. In 2013, I partnered with hospital performance services to build a mechanism and platform to track quality and safety outcomes across our health system in real time with easy to access web links. It took several years to perfect all these pre-scripted and standardized searches, but at this time I can really see all quality data for our spine group and for each surgeon and compare surgeons to local and national peer groups in a click of a button.

I can track data on every single patient we treat in the inpatient or outpatient settings. Since that time, we have tracked all quality and safety outcomes data for the spine division and the neurosurgery department, including hundreds of outcomes and metrics such as mortality index, readmissions, complications, patient satisfaction, and many others. We built an easy-to-digest dashboard that I send out to all spine surgeons on a regular basis, and it includes case reviews that shows opportunities for quality improvement, as well as benchmarks and champions. The use of this data is key in the creation, success, and monitoring of all of our many QI initiatives. Every few months, I add a new initiative and we design and track lead and lag metrics based on these locally created spine performances services databases which have risk adjustment from Vizient.

Q. How would you define “quality” in terms of healthcare and spine surgery?

Dr. Gottfried: I think there is quite a bit of conversation about trying to maximize improving quality outcomes and value. The bottom line is we must have great patient outcomes at the individual and at the total population level without major complications or significant morbidity, with high survival rates, with longevity and low risk of treatment recidivism, improving patients’ quality of life, maximizing patient satisfaction with all interventions, and we must do all of these efforts in the most efficient manner for the least amount of money. There is no way to achieve these results without seeing our data real time. Surgeon quality and value dashboard delivered regularly with appropriate benchmarks in an easy to digest fashion is a key first step to improvement. The next step is designing simple but efficacious initiatives for a group that can promote safety and quality care with little to no disruptions to a busy spine surgeon’s practice. I have been fortunate to have an engaged group to roll out these efforts to, and I enjoy not just facilitating ideal outcomes for my practice but for our entire group.