Apples, oranges, and national databases: commentary on an article by Daniel D. Bohl, MPH, et al.: "Variations in data collection methods between national databases affect study results: a comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures".

Abstract

The evolving model of health-care delivery in the United States has necessitated a closer evaluation of how we deliver musculoskeletal medicine. Population-based medicine will shift reimbursement models to financially reward quality and value. Organizations will be paid a fee for the care of a population of patients. Maintaining a healthy population will result in fewer hospitalizations and the necessity of expensive medical services. Although opponents may argue that patients will receive poorer treatment with this strategy in cost control, maintaining a healthy population through preventative care, lifestyle support, improved outpatient management of patients with chronic diseases, and helping people remain active will be the foundation of keeping the covered population healthy. Ultimately, it is postulated that health-care organizations will be financially successful if they are successful in sustaining a healthy population. Orthopaedic surgeons will be an integral component of this new model. Our care of people restores function, improves quality of life, and allows individuals to remain active and working. The initial increased cost of operative and nonoperative treatment of musculoskeletal disease meets the vital need of keeping individuals active and healthy. The initial upfront costs of arthroscopic surgery, total joint arthroplasty, or spine surgery provide both quality and long-term value. Unfortunately, our rapidly expanding armamentarium of technologically advanced interventions has often grown more rapidly than the clinical evidence and outcome studies to support their use. The challenge for the future to be able to deliver both quality and value is to identify what interventions work …