Neurosurgery clinics of North America
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Widespread adoption of electronic medical records (EMRs) in the United States is transforming the practice of medicine from a paper-based cottage industry into an integrated health care delivery system. Most physicians and institutions view the widespread use of EMRs to be inevitable. ⋯ Many have questioned whether the substantial investment in electronic health records has really been justified by improved patient outcomes or quality of care. This article describes historical and recent efforts to use EMRs to improve the quality of patient care, and provides a roadmap of EMR uses for the foreseeable future.
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The US health care system is currently undergoing a paradigm shift from pay-for-service toward pay-for-performance reimbursement, with a focus on quality measures and patient satisfaction. An important tool gaining increasing emphasis during the quality revolution is the surgical checklist. ⋯ Although other fields have pioneered the checklist revolution, neurosurgery is now beginning to follow suit. The authors review the available published neurosurgical checklists and their early results on patient safety.
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Medical errors are common and dangerous, estimated to cause over 400,000 deaths per year in the United States alone. The field of neurosurgery is not immune to these errors, and many studies have begun analyzing the frequency and types of errors that neurosurgical patients experience, along with their effects and causes. Fortunately, these data are guiding new innovations to reduce and prevent errors, like checklists, computerized order entry, and an increased appreciation for volume-outcome relationships. This article describes the epidemiology of errors, their classification, methods for identifying and discovering errors, and new strategies for error prevention.
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Neurosurg. Clin. N. Am. · Apr 2015
ReviewEconomics, innovation, and quality improvement in neurosurgery.
Innovation to improve patient care quality is a priority of the neurosurgical specialty since its beginnings. As the strain on health care resources increases, the cost of these quality improvements is becoming increasingly important. The aims of this article are to review the available tools for assessing the cost of quality improvement along with the willingness to pay and to provide a conceptual framework for the assessment of innovations in terms of quality and economic metrics and provide examples from the neurosurgical literature.
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Cost and value are increasingly important components of health care discussions. Despite a plethora of cost and cost-effectiveness analyses in many areas of medicine, there has been little of this type of research for neurosurgical procedures. ⋯ This article discusses the general principles of cost-effectiveness analyses and reviews the cost- and cost-effectiveness-related research to date in neurosurgical subspecialties. The need for standardization of cost and cost-effectiveness measurement and reporting within neurosurgery is highlighted and a set of metrics for this purpose is defined.