Quality Improvement in Neurosurgery
P re f a c e Q u a l i t y Im p ro v e m e n t i n N e u ro s u r g e r y
John D. Rolston, MD, PhD
Seunggu J. Han, MD
Andrew T. Parsa, MD, PhD
Editors
Human Services to define the goals for modern health care QI: 1. “Better Care: Improve the overall quality of care, by making health care more patientcentered, reliable, accessible, and safe.” 2. “Healthy People/Healthy Communities: Improve the health of the US population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.” 3. “Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.” Because of the government’s involvement, engagement in QI initiatives is no longer optional for providers of health care. Reimbursements are being tied to quality measures through ValueBased Purchasing, Pay-for-Performance, and the creation of Accountable Care Organizations. Data on quality of care provided by individuals and institutions are becoming available to patients. Participation in registries and QI programs is also now tied to reimbursements from the Centers for Medicare and Medicaid Services. Because of these changes, it is more important than ever for neurosurgeons to understand the process of QI, to see how it can ultimately improve the health of their patients, and to engage in critically evaluating the evidence behind quality measures and processes. This issue of Neurosurgery
Neurosurg Clin N Am 26 (2015) xiii–xiv http://dx.doi.org/10.1016/j.nec.2015.01.001 1042-3680/15/$ – see front matter Ó 2015 Published by Elsevier Inc.
neurosurgery.theclinics.com
Health care workers want to provide the best care they can, and patients demand it. Moreover, our society wishes this care to be safe, efficient, and economically sustainable. Achieving these goals is the subject of quality improvement (QI), an ever-growing collection of systems and studies targeted at improving patient outcomes and the processes that achieve them. The recognized need for QI in health care is not new, appearing at various key moments first described in Ernest Codman’s “End Result System,”1 later with the formation of the Joint Commission in 1952,2 and more recently the publication of To Err is Human by the Institute of Medicine in 1999.3 But the scope of quality studies is steadily growing, most recently with an increasingly sharp focus on health economics and the idea of value-based purchasing.4 Unlike many other disciplines in medicine, QI is intimately associated with governing and regulatory systems. Drivers of QI have long included physician-led systems like the American Medical Association and the American College of Surgeons, but the US Federal Government is also highly invested, predominantly after the creation of Medicare and Medicaid in 1965 made it economically critical to do so.5,6 More recently, with the passage of the Affordable Care Act in 2010, the importance of QI has been repeatedly reiterated.7 In a 2012 report to Congress,8 the “Triple Aim” was outlined by the Department of Health and
xiv
Preface Clinics of North America is an attempt to gather much of this information in a single resource, with a focus on QI as it relates to neurosurgeons and neurosurgery departments. Our hope is that the following articles provide concise starting points on the primary issues of QI in neurosurgery. The editors would like to acknowledge Catherine Y. Lau, MD for her contributions to this article. John D. Rolston, MD, PhD Department of Neurological Surgery University of California, San Francisco San Francisco, CA 94143, USA Seunggu J. Han, MD Department of Neurological Surgery University of California, San Francisco San Francisco, CA 94143, USA Andrew T. Parsa, MD, PhD Department of Neurological Surgery Northwestern University Feinberg School of Medicine Chicago, IL 60611, USA E-mail addresses: [email protected] (J.D. Rolston) [email protected] (S.J. Han) [email protected] (A.T. Parsa)
REFERENCES 1. Donabedian A. The end results of health care: Ernest Codman’s contribution to quality assessment and beyond. Milbank Q 1989;67:233–56 [discussion: 257–67].
2. Roberts JS, Coale JG, Redman RR. A history of the Joint Commission on Accreditation of Hospitals. JAMA 1987;258:936–40. 3. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000. 4. Rowe JW. Pay-for-performance and accountability: related themes in improving health care. Ann Intern Med 2006;145:695–9. 5. United States Congress House Committee on Ways and Means. Subcommittee on Health. Medicare quality of care, and outcomes and effectiveness research: hearing before the Subcommittee on Health of the Committee on Ways and Means, House of Representatives, One Hundred Second Congress, first session, April 30, 1991. Washington, DC: U.S. G.P.O.: For sale by the U.S. G.P.O., Supt. of Docs., Congressional Sales Office; 1991. 6. United States Congress Senate Committee on Finance. Subcommittee on Medicare and LongTerm Care. Medicare quality assurance: hearing before the Subcommittee on Medicare and Long-Term Care of the Committee on Finance, United States Senate, One Hundred Second Congress, first session, February 22, 1991. Washington, DC: U.S. G.P.O.: For sale by the U.S. G.P.O., Supt. of Docs., Congressional Sales Office; 1991. 7. Butler PD, Chang B, Britt LD. The Affordable Care Act and academic surgery: expectations and possibilities. J Am Coll Surg 2014;218:1049–55. 8. Annual Progress Report to Congress. National Strategy for Quality Improvement in Health Care. Available at: http://www.ahrq.gov/workingforquality/nqs/ nqs2012annlrpt.pdf. Accessed August 1, 2014.
P re f a c e Q u a l i t y Im p ro v e m e n t i n N e u ro s u r g e r y
John D. Rolston, MD, PhD
Seunggu J. Han, MD
Andrew T. Parsa, MD, PhD
Editors
Human Services to define the goals for modern health care QI: 1. “Better Care: Improve the overall quality of care, by making health care more patientcentered, reliable, accessible, and safe.” 2. “Healthy People/Healthy Communities: Improve the health of the US population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.” 3. “Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.” Because of the government’s involvement, engagement in QI initiatives is no longer optional for providers of health care. Reimbursements are being tied to quality measures through ValueBased Purchasing, Pay-for-Performance, and the creation of Accountable Care Organizations. Data on quality of care provided by individuals and institutions are becoming available to patients. Participation in registries and QI programs is also now tied to reimbursements from the Centers for Medicare and Medicaid Services. Because of these changes, it is more important than ever for neurosurgeons to understand the process of QI, to see how it can ultimately improve the health of their patients, and to engage in critically evaluating the evidence behind quality measures and processes. This issue of Neurosurgery
Neurosurg Clin N Am 26 (2015) xiii–xiv http://dx.doi.org/10.1016/j.nec.2015.01.001 1042-3680/15/$ – see front matter Ó 2015 Published by Elsevier Inc.
neurosurgery.theclinics.com
Health care workers want to provide the best care they can, and patients demand it. Moreover, our society wishes this care to be safe, efficient, and economically sustainable. Achieving these goals is the subject of quality improvement (QI), an ever-growing collection of systems and studies targeted at improving patient outcomes and the processes that achieve them. The recognized need for QI in health care is not new, appearing at various key moments first described in Ernest Codman’s “End Result System,”1 later with the formation of the Joint Commission in 1952,2 and more recently the publication of To Err is Human by the Institute of Medicine in 1999.3 But the scope of quality studies is steadily growing, most recently with an increasingly sharp focus on health economics and the idea of value-based purchasing.4 Unlike many other disciplines in medicine, QI is intimately associated with governing and regulatory systems. Drivers of QI have long included physician-led systems like the American Medical Association and the American College of Surgeons, but the US Federal Government is also highly invested, predominantly after the creation of Medicare and Medicaid in 1965 made it economically critical to do so.5,6 More recently, with the passage of the Affordable Care Act in 2010, the importance of QI has been repeatedly reiterated.7 In a 2012 report to Congress,8 the “Triple Aim” was outlined by the Department of Health and
xiv
Preface Clinics of North America is an attempt to gather much of this information in a single resource, with a focus on QI as it relates to neurosurgeons and neurosurgery departments. Our hope is that the following articles provide concise starting points on the primary issues of QI in neurosurgery. The editors would like to acknowledge Catherine Y. Lau, MD for her contributions to this article. John D. Rolston, MD, PhD Department of Neurological Surgery University of California, San Francisco San Francisco, CA 94143, USA Seunggu J. Han, MD Department of Neurological Surgery University of California, San Francisco San Francisco, CA 94143, USA Andrew T. Parsa, MD, PhD Department of Neurological Surgery Northwestern University Feinberg School of Medicine Chicago, IL 60611, USA E-mail addresses: [email protected] (J.D. Rolston) [email protected] (S.J. Han) [email protected] (A.T. Parsa)
REFERENCES 1. Donabedian A. The end results of health care: Ernest Codman’s contribution to quality assessment and beyond. Milbank Q 1989;67:233–56 [discussion: 257–67].
2. Roberts JS, Coale JG, Redman RR. A history of the Joint Commission on Accreditation of Hospitals. JAMA 1987;258:936–40. 3. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000. 4. Rowe JW. Pay-for-performance and accountability: related themes in improving health care. Ann Intern Med 2006;145:695–9. 5. United States Congress House Committee on Ways and Means. Subcommittee on Health. Medicare quality of care, and outcomes and effectiveness research: hearing before the Subcommittee on Health of the Committee on Ways and Means, House of Representatives, One Hundred Second Congress, first session, April 30, 1991. Washington, DC: U.S. G.P.O.: For sale by the U.S. G.P.O., Supt. of Docs., Congressional Sales Office; 1991. 6. United States Congress Senate Committee on Finance. Subcommittee on Medicare and LongTerm Care. Medicare quality assurance: hearing before the Subcommittee on Medicare and Long-Term Care of the Committee on Finance, United States Senate, One Hundred Second Congress, first session, February 22, 1991. Washington, DC: U.S. G.P.O.: For sale by the U.S. G.P.O., Supt. of Docs., Congressional Sales Office; 1991. 7. Butler PD, Chang B, Britt LD. The Affordable Care Act and academic surgery: expectations and possibilities. J Am Coll Surg 2014;218:1049–55. 8. Annual Progress Report to Congress. National Strategy for Quality Improvement in Health Care. Available at: http://www.ahrq.gov/workingforquality/nqs/ nqs2012annlrpt.pdf. Accessed August 1, 2014.
