Skip to main content

Quality Improvement

  • Chapter
  • First Online:
Book cover Cerebrovascular and Endovascular Neurosurgery

Abstract

The field of quality improvement in cerebrovascular neurosurgery is being driven by data that has little clinical or technical relevancy. Consumers are hungry for data that is simple and easy to access and understand. The government and insurance companies are stratifying neurosurgeons in order to cut healthcare cost. Cerebrovascular neurosurgeons spent little time defining their own specific quality measures in their field. They have reasonably been focused on refining their ability to treat complex cerebrovascular pathologies, requiring some of the most technically challenging and critical decision-making capabilities of all of neurosurgery. However, the current quality measures applied for reimbursement and ratings does not take this into account. Rather cerebrovascular neurosurgeons are being rated and reimbursed based on measures such as the number of UTIs a patient has or whether their hospital has an Alzheimer’s unit. Here we discuss the evolution of quality improvement that started with internal assessments limited to physicians with expertise in their respective fields, to the current state where the reimbursement and acknowledgment of our practice is being driven by social media through consumer satisfaction, government, private, and insurance companies. Measurable outcomes determine the progress of a field. To continue evolution of this complex field of cerebrovascular neurosurgery, there is a need for internal development and application of specific quality improvement measures that are relevant to cerebrovascular neurosurgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Al Kawi MZ. History of medical records and peer review. Ann Saudi Med. 1997;17:277–8.

    Article  PubMed  Google Scholar 

  2. Ajlouni KM, Al-Khalidi U. Medical records, patient outcome, and peer review in eleventh-century Arab medicine. Ann Saudi Med. 1997;17:326–7.

    Article  CAS  PubMed  Google Scholar 

  3. Donabedian A. The end results of health care: ernest Codman’s contribution to quality assessment and beyond. Milbank Q. 1989;67:233–56.

    Article  CAS  PubMed  Google Scholar 

  4. Orlander J, Barber T, Fincke B. The morbidity and mortality conference: the delicate nature of learning from error. Acad Med. 2002;77(10):1001–6.

    Article  PubMed  Google Scholar 

  5. Campbell W. Surgical morbidity and mortality meetings. Ann R Coll Surg Engl. 1988;70(6):363–5.

    PubMed  PubMed Central  CAS  Google Scholar 

  6. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.

    Google Scholar 

  7. Rolston JD, Seunggu JH, Parsa AT. Quality improvement in neurosurgery. Neurosurg Clin N Am. 2015;26(2):xiii–xiv.

    Article  PubMed  Google Scholar 

  8. Olmsted MR, Geinsen E, Musphy J, Bell D, Morley M, Stanley M. Methodology: U.S. News & World Report Best Hospitals 2014–15. 2016. http://www.usnews.com/pubfiles/BH_2014_Methodology_Report_Final_Jul14.pdf. Accessed 27 Apr 2016.

  9. Rosenthal E. The hype over hospital rankings. The New York Times. 2013. http://www.nytimes.com/2013/07/28/sunday-review/the-hype-over-hospital-rankings.html?_r=0. Accessed 13 Sept 2016.

  10. UHC Website. United Healthcare Consortium. https://www.uhc.edu/cps/rde. Accessed 21 Sept 2016.

  11. Roberts JS, Coale JG, Redman RR. A history of the Joint Commission on Accreditation of Hospitals. JAMA. 1987;258:936–40.

    Article  CAS  PubMed  Google Scholar 

  12. The Joint Commission. Facts about federal deemed status and state recognition. https://www.jointcommission.org/facts_about_federal_deemed_status_and_state_recognition/. Accessed 21 Sept 2016.

  13. Butler PD, Chang B, Britt LD. The affordable care act and academic surgery: expectations and possibilities. J Am Coll Surg. 2014;218:1049–55.

    Article  PubMed  Google Scholar 

  14. PQRS. What neurosurgeons need to know 05.15.16. 2016. http://www.aans.org/Legislative%20Activities/Patient%20Safety%20and%20Quality%20Improvement.aspx. Accessed 14 Sept 2016.

  15. QOD. The Quality Outcomes Database. http://www.neuropoint.org/NPA%20N2QOD.aspx. Accessed 21 Sept 2016.

  16. NVQI. Neurovascular Quality Initiative. Available at: http://nvqi.org/. Accessed 11 Mar 2017.

  17. Get With The Guidelines. Stroke overview. http://www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelines/GetWithTheGuidelines-Stroke/Get-With-The-Guidelines-Stroke-Overview_UCM_308021_Article.jsp#.VyEyYCnXJH0. Accessed 27 April 2016.

  18. AHA/ASA Outlines. Metrics for measuring quality of care in Comprehensive Stroke Centers. American Heart Association/American Stroke Association recommendations: a statement for healthcare professionals from the detailed follow up to Brain Attack Coalition Comprehensive Stroke Center. Stroke. 2011;42:849–77.

    Article  Google Scholar 

  19. Tong D, Reeves MJ, Hernandez AF, Zhao X, Olson DM, Fonarow GC, Schwamm LH, Smith EE. Times from symptom onset to hospital arrival in the get with the guidelines—Stroke Program 2002 to 2009: temporal trends and implications. Stroke. 2012;43(7):1912–7.

    Article  PubMed  Google Scholar 

  20. Gonzalez LF and Mocco JD. Cerebrovasuclar neurosurgery and outcomes. Assessing quality. How do neurosurgeons measure up? Congress Quarterly. 2013. https://www.cns.org/system/files/congress_quarterly/CNSQ_13spring_0.pdf. Accessed 21 Sept 2016.

  21. Sternberg S. Medicare’s new hospital ratings draw immediate ire. US News Magazine. 2016. http://www.usnews.com/news/articles/2016-07-27/medicare-releases-controversial-hospital-star-ratings. Accessed 14 Sept 2016.

  22. Birkmeyer JD, Finks JF, O’Reilly A, et al. Michigan bariatric surgery collaborative. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013;368(15):1434–42.

    Article  CAS  Google Scholar 

  23. Comprehensive Stroke Center Requirements. DNV-GL Website. https://issuu.com/dnvbaus/docs/2015levelcomprehensivestroke_progra?e=5700932/33413838. Accessed 21 Sept 2016.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L. Fernando Gonzalez M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cobb, M.IP.H., Zomorodi, A.R., Gonzalez, L.F. (2018). Quality Improvement. In: Gandhi, C., Prestigiacomo, C. (eds) Cerebrovascular and Endovascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-65206-1_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-65206-1_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65204-7

  • Online ISBN: 978-3-319-65206-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics