Quality Improvement InNeurosurgery

Definition of Quality

Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

Creating National Awareness

Institute of Medicine Reports-To Err Is Human 1999

-Crossing The Quality Chasm 2001

-Preventing Medical Errors 2006

Goal: Improve quality and operational efficiency and reduce costs

Why Safety as priority?

• Ethical obligation to provide reliably safe high quality care

• Complexity of care and potential for inadvertent harm

• Regulation, Pay for performance

• Opportunities to be more efficient

• Malpractice Premiums

• We will all be patients some day

Like it or not, we are being watched CMS AHRQ

Agency for Healthcare Research and Quality

CAHPS Consumer Assessment of

Healthcare Providers and Systems

NCQA National Committee for Quality

Assurance State Medical Boards PQRI Hospitals Lawyers

Institute of Medicine: “Quality Chasm” Report

• Best practices as organizational standards• Use of information technology • Improve workforce knowledge and skills• Develop effective teams • Coordination of care for complex patients• Develop informative measurements for

performance and outcomes

Model for Improvement

What do we want to fix?

Need for Measurement

Improvement is not measurement. But measurement plays an important role:

•Key measures are required to assess progress on team’s aim

•Data from the system can be used to focus improvement and refine changes

What can you do now to improve quality?

• What ideas do you have that you feel could improve patient care?

Surgical site infection?Ventricular drain infection?

AED use and overuse?Venous thromboembolism prophylaxis?

A General Approach to Developing Measures

• Collect data before and after making changes• Less than six measures • Useful and manageable• Feasible!

Possible EVD Infection Reduction Measures

Dressing intactCSF sampling protocol followedDays in place

Data Collection for Measures

• Include the collection of data with another current work activity (check if EVDs are dressed on rounds)

• Develop an easy-to-use data collection form  • Define roles for on going data collection• Set aside time to review data

Why me, I’m just a resident?

Quality Improvement “It’s about the patient!”

Enhance reputation National leadership in quality research

Leadership opportunity Influence policy initiatives

Quality measures, P4P, N2QOD Grant opportunities

CMS/NIH/AHRQ/Foundations

Suggestions• Junior Resident Projects

• Lower the incidence of surgical site infections, PVT/PE

• Intermediate Resident Projects• Improving Emergency Transfer times. • Improving the time to the OR during emergencies

• Senior Resident Projects• Improving interdisciplinary care in complex disorders

(ie. Vascular, Functional) • Reviewing & publishing outcomes in complex

neurosurgical conditions

Physician Quality Reporting Initiative

CMS: Carrot then the Stick

Current Trends & Hot Buttons

• Linking payment to quality– “Pay for Performance”– “Never” events

• Evidence-based practice initiatives• Public reporting & consumer-driven health care• Adoption of information technology

National Neurosurgery Quality and Outcomes Database (N2QOD)

• Goal: to generate performance benchmarks and value of care (locally and nationally)

• Endorsed by AANS, CNS, ABNS, Senior Society • Multicenter collection of neurosurgery data for most

common procedures• Establish risk-adjusted expected morbidity and one-year

outcomes for the most common neurosurgical procedures

• Generate nationwide quality and efficacy data to support claims made to CMS

Institute of Medicine: “Quality Chasm” Report

“Quality problems occur typically not because of failure of goodwill, knowledge, effort or resources devoted to health care, but because of fundamental shortcomings in the ways care is organized”

Trying harder will not work:Changing systems of care will!