Determining the elements of procedural quality

Clinical article

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The definition and determination of quality health care is an important topic. The purpose of this study was to develop a longitudinal method to define a quality procedure by creating a formal approach to pre- and postoperative outcomes documentation. The authors worked to define quality outcomes by first documenting the patient's condition. Goals were determined together by the surgeon and the patient and then were evaluated to see if those goals were met.


The population consisted of cancer patients with newly diagnosed metastatic brain disease who were scheduled to undergo stereotactic radiosurgery. Surgeons recorded perioperatively objective information related to preoperative goals, clinical findings, surgical performance and/or error, and whether goals were met. In addition, patients completed pre- and postprocedure questionnaires (Rand 36-Item Short-Form Health Survey 1.0 [SF-36]).


Procedural goals, defined as completing radiosurgery without error or complication and same-day discharge, were met in all patients. The clinically predetermined goal of tumor palliation was met in all but 1 patient at follow-up. The SF-36 scores remained stable except for the general health domain, which was lower (p = 0.006).


Procedural goals can be defined and objectively measured serially. The authors think that quality care can be defined as a process that achieves predefined goals without significant error and maintains or improves health.

Abbreviations used in this paper:GKS = Gamma Knife surgery; QOL = quality of life; SF-36 = Rand 36-Item Short-Form Health Survey 1.0; WBRT = whole-brain radiation therapy.

Article Information

Address correspondence to: Douglas Kondziolka, M.D., Department of Neurosurgery, NYU Langone Medical Center, New York University, 530 First Avenue, New York, New York 10016. email:

Please include this information when citing this paper: published online February 8, 2013; DOI: 10.3171/2013.1.JNS111681.

© AANS, except where prohibited by US copyright law.



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    Bar graph showing baseline (gray bars) and follow-up (black bars) normalized SF-36 scores in each of the 8 measured domains.

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    Scheme for tracking and scoring procedures. Provides a relative value for occurrences in each aspect of care. ↑ = extended.



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