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Wilson AM, Lundgren KB, Schierman B, Mante A, Lien A, Benish SM, Esper GJ, Nair KV, Ney JP. Examining the National Representativeness of the Axon Registry: A Neurology-Specific Patient Registry. Neurology 2023; 101:e1167-e1177. [PMID: 37487753 PMCID: PMC10513878 DOI: 10.1212/wnl.0000000000207601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/15/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to determine the external validity of the Axon Registry by comparing the 2019 calendar year data with 2 nationally representative, publicly available data sources, specifically the National Ambulatory Medical Care Survey (NAMCS) and the Medical Expenditure Panel Survey (MEPS). The Axon Registry is the American Academy of Neurology's neurology-focused qualified clinical data registry that reports and analyzes electronic health record data from participating US neurology providers. Its key function is to support quality improvement within ambulatory neurology practices while also promoting high-quality evidence-based care in clinical neurology. We compared demographics of patients who had an outpatient or office visit with a neurologist along with prevalence of selected neurologic conditions and neurologic procedures across the 3 data sets. METHODS We performed a cross-sectional, retrospective comparison of 3 data sets: NAMCS (2012-2016), MEPS (2013-2017, 2019), and Axon Registry (2019). We obtained patient demographics (age, birth sex, race, ethnicity), patient neurologic conditions (headache, epilepsy, cerebrovascular disease, multiple sclerosis, parkinsonism, dementia, spinal pain, and polyneuropathy), provider location, and neurologic procedures (neurology visits, MR/CT neuroimaging studies and EEG/EMG neurophysiologic studies). Parameter estimates from the pooled 5-year samples of the 2 public data sets, calculated at the visit level, were compared descriptively with those of the Axon Registry. We calculated Cohen h and performed Wald tests (α = 0.05) to conduct person-level statistical comparisons between MEPS 2019 and Axon Registry 2019 data. RESULTS The Axon Registry recorded 1.3 M annual neurology visits (NAMCS, 11 M; MEPS, 22 M) and 645 K people with neurologic conditions (MEPS, 10 M). Compared with the pooled national surveys, the Axon Registry has similar patient demographics, neurologic condition prevalence, neuroimaging and neurophysiologic utilization, and provider location. In direct comparison with MEPS 2019, the Axon Registry 2019 had fewer children (2% vs 7%), more elderly persons (21% vs 16%), fewer non-Black and non-White race persons (5% vs 8%), less number of patients with epilepsy (10% vs 13%), more patients with dementia (8% vs 6%), more patients with cerebrovascular disease (11% vs 8%), and a greater predominance of neurology providers in the Midwest (25% vs 20%). The only difference with a non-negligible effect size was the proportion of people younger than 15 years (Cohen h = 0.25). DISCUSSION The Axon Registry demonstrates high concordance with 2 nationally representative surveys. Recruiting more and diverse neurology providers will further improve the volume, representativeness, and value of the Axon Registry.
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Affiliation(s)
- Andrew M Wilson
- From the Department of Neurology (A.M.W.), University of California, Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, Los Angeles, CA; American Academy of Neurology (K.B.L., B.S., A.M.), Minneapolis, MN; Verana Health (A.L.), San Francisco, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; Department of Neurology (K.V.N.), University of Colorado, Denver; and Department of Neurology (J.P.N.), Edith Nourse Rogers VA Medical Center, Bedford, MA.
| | - Karen B Lundgren
- From the Department of Neurology (A.M.W.), University of California, Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, Los Angeles, CA; American Academy of Neurology (K.B.L., B.S., A.M.), Minneapolis, MN; Verana Health (A.L.), San Francisco, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; Department of Neurology (K.V.N.), University of Colorado, Denver; and Department of Neurology (J.P.N.), Edith Nourse Rogers VA Medical Center, Bedford, MA
| | - Becky Schierman
- From the Department of Neurology (A.M.W.), University of California, Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, Los Angeles, CA; American Academy of Neurology (K.B.L., B.S., A.M.), Minneapolis, MN; Verana Health (A.L.), San Francisco, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; Department of Neurology (K.V.N.), University of Colorado, Denver; and Department of Neurology (J.P.N.), Edith Nourse Rogers VA Medical Center, Bedford, MA
| | - Aristotle Mante
- From the Department of Neurology (A.M.W.), University of California, Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, Los Angeles, CA; American Academy of Neurology (K.B.L., B.S., A.M.), Minneapolis, MN; Verana Health (A.L.), San Francisco, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; Department of Neurology (K.V.N.), University of Colorado, Denver; and Department of Neurology (J.P.N.), Edith Nourse Rogers VA Medical Center, Bedford, MA
| | - Amanda Lien
- From the Department of Neurology (A.M.W.), University of California, Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, Los Angeles, CA; American Academy of Neurology (K.B.L., B.S., A.M.), Minneapolis, MN; Verana Health (A.L.), San Francisco, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; Department of Neurology (K.V.N.), University of Colorado, Denver; and Department of Neurology (J.P.N.), Edith Nourse Rogers VA Medical Center, Bedford, MA
| | - Sarah M Benish
- From the Department of Neurology (A.M.W.), University of California, Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, Los Angeles, CA; American Academy of Neurology (K.B.L., B.S., A.M.), Minneapolis, MN; Verana Health (A.L.), San Francisco, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; Department of Neurology (K.V.N.), University of Colorado, Denver; and Department of Neurology (J.P.N.), Edith Nourse Rogers VA Medical Center, Bedford, MA
| | - Gregory J Esper
- From the Department of Neurology (A.M.W.), University of California, Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, Los Angeles, CA; American Academy of Neurology (K.B.L., B.S., A.M.), Minneapolis, MN; Verana Health (A.L.), San Francisco, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; Department of Neurology (K.V.N.), University of Colorado, Denver; and Department of Neurology (J.P.N.), Edith Nourse Rogers VA Medical Center, Bedford, MA
| | - Kavita V Nair
- From the Department of Neurology (A.M.W.), University of California, Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, Los Angeles, CA; American Academy of Neurology (K.B.L., B.S., A.M.), Minneapolis, MN; Verana Health (A.L.), San Francisco, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; Department of Neurology (K.V.N.), University of Colorado, Denver; and Department of Neurology (J.P.N.), Edith Nourse Rogers VA Medical Center, Bedford, MA
| | - John P Ney
- From the Department of Neurology (A.M.W.), University of California, Los Angeles; Department of Neurology (A.M.W.), Greater Los Angeles Healthcare System, Los Angeles, CA; American Academy of Neurology (K.B.L., B.S., A.M.), Minneapolis, MN; Verana Health (A.L.), San Francisco, CA; Department of Neurology (S.M.B.), University of Minnesota, Minneapolis; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; Department of Neurology (K.V.N.), University of Colorado, Denver; and Department of Neurology (J.P.N.), Edith Nourse Rogers VA Medical Center, Bedford, MA
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Stenger M, Jakobsen E, Wright G, Zalcberg J, Stirling RG. A comparison of outcomes and survival between Victoria and Denmark in lung cancer surgery: opportunities for international benchmarking. ANZ J Surg 2021; 92:1050-1055. [PMID: 34676962 DOI: 10.1111/ans.17302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS Victoria (Australia) and Denmark have comparable population sizes and high-quality healthcare systems. Lung cancer surgery, however, is performed in more than 20 Victorian hospitals compared to four in Denmark. Such differences in centralization may influence outcomes. We engaged clinical quality registries to enable international benchmarking by exploring patterns of lung cancer surgery including mortality and survival. METHODS All patients undergoing lung cancer surgery between 2015 and 2018 registered in the Victorian Lung Cancer Registry and the Danish Lung Cancer Registry were included. Analyses on stage concordance, 30 and 90-day mortality, and overall survival were restricted to a selected subgroup with NSCLC and no neo-adjuvant therapy or metastatic disease and only one operation. RESULTS We included 1554 Victorian and 4319 Danish patients. The resection rate was 26.3% in Victoria and 28% in Denmark, but a higher proportion of Victorian patients underwent wedge resection (19.1% versus 8.8%). Stage concordance was 59.6% and 54.9% in Victoria and Denmark, respectively. The 30- and 90-day mortality was 1.3% and 2.6% in Victoria, compared to 1.4% and 2.8% in Denmark with no difference in overall survival (p = 0.28) or risk-adjusted survival (HR: 1.10 (95% CI: 0.89-1.37); p = 0.38). CONCLUSION High-quality surgical lung cancer care was confirmed by similar high resection and low mortality rates including no overall survival difference. The drivers and consequences of stage discordance and differences in patterns of resection deserve further exploration. This study provides a model for international benchmarking using clinical quality registries, although caution remains in the interpretation given disparities in data completeness.
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Affiliation(s)
- Michael Stenger
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Erik Jakobsen
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Gavin Wright
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert G Stirling
- Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Doby BL, Ross-Driscoll K, Shuck M, Wadsworth M, Durand CM, Lynch RJ. Public discourse and policy change: Absence of harm from increased oversight and transparency in OPO performance. Am J Transplant 2021; 21:2646-2652. [PMID: 33565252 DOI: 10.1111/ajt.16527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/31/2021] [Indexed: 01/25/2023]
Abstract
The Centers for Medicare and Medicaid Services announced changes to the Final Rule for organ procurement organizations (OPOs) in November 2020, after a 23-month period of public debate. One concern among transplant stakeholders was that public focus on OPO underperformance would harm deceased donation. Using CDC-WONDER data, we studied whether donation performance dropped during the era of public debate about OPO reform (December 2018-February 2020). Overall OPO performance as measured relative to cause, age, and location-consistent deaths rose by 12.3% in 2019, compared to a median annual change of 2.5% 2009-2019. Organ recoveries exceeded seasonally adjusted forecasts by 4.2% in the first half of 2019, by 8.1% following the Executive Order issuing a mandate for OPO metric reform, and by 14.1% between the Notice of Public Rule Making and the onset of COVID-19-related systemic disruptions. We describe changes in donor phenotype in the period of increased performance; improvement was greatest for older and donation after cardiac death (DCD) donors, and among decedents who did not have a drug-related mechanism of death. In summary, performance during an era of intense public debate and proposed regulatory changes yielded 692 additional donors over expectations, and no detriment to organ donation was observed.
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Affiliation(s)
- Brianna L Doby
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katie Ross-Driscoll
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raymond J Lynch
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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