The current growth in medical costs is unsustainable, and many health care observers believe that health care quality is inconsistent. In this environment, “value-based” reforms are being adopted by most stakeholders to help achieve sustainability of the current US health care system. Challenges to value-based approaches include the facts that optimal health care outcomes for many medical conditions remain poorly defined, and that high-level evidence regarding the effectiveness of many diagnostic and therapeutic services is limited. Furthermore, valid methods to continuously measure, promote, and report safety and quality in health care are underdeveloped (particularly in specialty medicine).
Responses to these challenges have included the creation of intelligent observational data collection systems, such as clinical registries. Prospective observational registries are designed to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, while measuring and adjusting for the patient, disease, and health services covariates influencing those outcomes. These methods are being promoted by all major health care stakeholders, and these groups are also playing a role in determining how these systems will be used to define, measure, and report the quality and value of medical services.
The use of patient care data to measurably improve the quality of care and more efficiently allocate health care resources is reshaping modern medical practice, and represents the future of health care. This issue of Neurosurgical Focus is dedicated to original scientific contributions focused on methods to define neurosurgical quality from the perspective of multiple stakeholders, to accurately measure that quality, and to use accumulated data to predict and improve outcomes of care for individuals or patient populations. The issue contains papers addressing the following 6 major topics that are of critical importance to all neurosurgeons.
An examination of “big data” approaches to valuebased, patient-focused health care reform.
Descriptive analyses of evolving national and regional clinical registries relevant to neurosurgical practice.
A description of the first national project to develop and implement specialty-specific quality measures for neurosurgeons.
Examples of how clinical databases are being used to describe and improve neurosurgical quality.
Methods to improve clinical data collection efficiencies.
A primer on health care policy relevant to clinical databases.
In summary, data derived from everyday patient care will be central to the largest transformation of health care processes in modern history. Every day, evidence that neurosurgeons need to improve care and shape our own destiny is created in actual practice. If each of us embraces quality science and its methods as essential components of modern neurosurgical practice, we will meet the challenges of creating a sustainable health care system. Additionally we, as a specialty, will define the relevance of cranial and spinal surgery within the broader realm of medicine, and in modern society.
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