Neurosurg Focus
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Outcomes-directed approaches to quality improvement have been adopted by diverse industries and are increasingly the focus of government-mandated reforms to health care education and delivery. The authors identify and review current reform initiatives originating from agencies regulating and funding graduate medical education and health care delivery. These reforms use outcomes-based methodologies and incorporate principles of lifelong learning and patient centeredness. ⋯ Opportunities exist to coordinate and unify patient outcomes measurement throughout neurosurgical training and practice, enabling effective patient-centered improvements in care delivery as well as efficient compliance with regulatory mandates. Coordination will likely require the development of a new science of practice based in the daily clinical environment and utilizing clinical data registries. A generation of outcomes science and quality experts within neurosurgery should be trained to facilitate attainment of these goals.
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Given the unsustainable costs of US health care, universal agreement exists among payers, regulatory agencies, and other health care stakeholders that reform must include substantial improvements in the quality, effectiveness, and value of health care delivery. The Institute of Medicine and the American Recovery and Reinvestment Act of 2009 have called for the establishment of prospective registries to capture patient-centered data from real-world practice as a high priority to guide evidence-based reform. As a result, the American Association of Neurological Surgeons launched the National Neurosurgery Quality and Outcomes Database (N(2)QOD) and began enrolling patients in March 2012 into its initial pilot project: a web-based lumbar spine module. ⋯ Once national benchmarks of quality and effectiveness are accurately established and validated utilizing practice-based data extractors in the pilot year, N(2)QOD aims to introduce non-full-time employee (FTE)-dependent methodologies such as electronic medical record auto-extraction. N(2)QOD's non-FTE-dependent methodologies can then be validated against practice-based data extractor-derived measures of safety and effectiveness with the aim of more rapid expansion into the majority of US practice groups. The general overview, methods, and registry design of the N(2)QOD pilot year (lumbar module) are presented here.
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Patient care data will soon inform all areas of health care decision making and will define clinical performance. Organized neurosurgery believes that prospective, systematic tracking of practice patterns and patient outcomes will allow neurosurgeons to improve the quality and efficiency and, ultimately, the value of care. In support of this mission, the American Association of Neurological Surgeons, in cooperation with a broad coalition of other neurosurgical societies including the Congress of Neurological Surgeons, Society of Neurological Surgeons, and American Board of Neurological Surgery, created the NeuroPoint Alliance (NPA), a not-for-profit corporation, in 2008. ⋯ To meet the growing need for tools to measure and promote high-quality care, NPA collaborated with several national stakeholders to create an unprecedented program: the National Neurosurgery Quality and Outcomes Database (N(2)QOD). This resource will allow any US neurosurgeon, practice group, or hospital system to contribute to and access aggregate quality and outcomes data through a centralized, nationally coordinated clinical registry. This paper describes the practical and scientific justifications for a national neurosurgical registry; the conceptualization, design, development, and implementation of the N(2)QOD; and the likely role of prospective, cooperative clinical data collection systems in evolving systems of neurosurgical training, continuing education, research, public reporting, and maintenance of certification.
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Anterior third ventricular lesions present with a variety of symptoms related to cerebrospinal fluid flow obstruction and mass effect. Colloid cysts are among the most common lesions in the region. They usually present with ventriculomegaly, leading to headaches, vertigo, or, rarely, decreased mental status due to the development of acute hydrocephalus. ⋯ The video can be found here: http://youtu.be/KzC8QYsTKeg. (http://thejns.org/doi/abs/10.3171/2013. V1. FOCUS12340)
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Endoscopic resection of colloid cyst in patients with normal-sized ventricular system is challenging, because the limited intraventricular space increases the risk of injuring eloquent nervous structures and critical blood vessels. The utilization of frameless stereotaxy and tissue shaving device facilitates the procedure. An important operative step is the ventricular insufflation that allows for an endoscope introduction without causing inadvertent injury to the caudate nucleus. ⋯ The video can be found here: http://youtu.be/zzYYZEsd-uk. (http://thejns.org/doi/abs/10.3171/2013. V1. FOCUS12329)