Department of Neurosurgery, University Hospital Muenster, Muenster, Germany.
Department of Neurosurgery, Haukeland University Hospital Bergen, Jonas Lies vei 71, Bergen, 5021, Norway.
Neurosurg Rev. 2024 Oct 23;47(1):815. doi: 10.1007/s10143-024-03066-9.
In recent decades, there has been increasing interest in measuring the quality of care across all medical fields, including neurosurgery. This interest aims not only to optimize care but also to reduce healthcare costs. For this purpose, different quality indicators (QIs) have been developed. We performed a systematic review according to the PRISMA guidelines aiming at identifying studies that critically evaluate QIs applied in cranial neurosurgery. A total of 34 studies, suggesting 22 indicators, were identified. The most discussed indicator was the 30-day readmission rate, followed by the 30-day reoperation rate. The majority of QIs are influenced by baseline and underlying patient characteristics, reflecting the severity of the patient`s underlying disease, rather than adherence to best available evidence of treatment. Therefore, it is crucial to implement adequate risk adjustment strategies when applying QIs to compensate for differences in patient complexity and to ensure that departments that are treating high-risk patients do not have worse results. The review revealed several limitations of the currently used quality indicators. Most suggested indicators are attractive from a payer point of view, easy to measure and therefore convenient for reimbursement purposes. However, from a clinician's point of view, most indicators were considered poor performance markers as they do not correlate with meaningful outcome and do not reflect treatment quality. In addition, there is a lack of disease- and neurosurgery specific indicators. This highlights the need for clinicians to actively participate in developing more clinically relevant QIs tailored to neurosurgical practice.
近几十年来，人们对测量所有医学领域，包括神经外科的医疗质量越来越感兴趣。这种兴趣不仅旨在优化护理，还旨在降低医疗保健成本。为此，已经开发了不同的质量指标（QIs）。我们根据 PRISMA 指南进行了系统评价，旨在确定批判性评估应用于颅神经外科的 QIs 的研究。共确定了 34 项研究，提出了 22 个指标。讨论最多的指标是 30 天再入院率，其次是 30 天再次手术率。大多数 QIs 受到基线和潜在患者特征的影响，反映了患者潜在疾病的严重程度，而不是对最佳现有治疗证据的依从性。因此，在应用 QIs 时，实施适当的风险调整策略至关重要，以补偿患者复杂性的差异，并确保治疗高风险患者的科室不会产生更差的结果。该综述揭示了当前使用的质量指标存在的一些局限性。大多数建议的指标从支付者的角度来看很有吸引力，易于测量，因此便于报销目的。然而，从临床医生的角度来看，大多数指标被认为是不良绩效指标，因为它们与有意义的结果无关，也不反映治疗质量。此外，缺乏疾病和神经外科特定的指标。这突出表明需要临床医生积极参与制定更符合神经外科实践的更具临床相关性的 QIs。
