Quality Indicators in Cranial Neurosurgery: Which are presently substantiated? – A systematic review.
Due to rising costs in health care delivery, the quality of delivered care has become a central issue across all medical specialties. Consequently, there is an increasing pressure to create standardized frameworks for the measurement of quality. In the field of cranial neurosurgery, health care administrators have begun applying quality measures that are easily available, but might be inaccurate in measuring quality of care. We performed a systematic literature review on quality indicators that are presently employed in this field aiming to elucidate which quality indicators are scientifically founded and thus potentially justifiable as measures of quality. A total of eight quality indicators were found and studies were methodologically evaluated according to the AIRE (Appraisal of Indicators through Research and Evaluation) criteria. These included length of hospital stay, all cause readmission rate and unplanned reoperation rate. Our review indicates that these presently used or proposed quality indicators for neurosurgery lack scientific rigour and are restricted to rudimentary measures and that further research is necessary. Neurosurgeons need to define their own quality indicators and actively participate in the validation of these quality indicators to provide the best possible patient outcomes. More reliable clinical registries, obligatory for all neurosurgical services, should be established as a basis for the establishment of such indicators with risk-adjustment being an important element of any such indicators.
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length of stay; quality indicators; readmission rate; reoperation rate