Value-based Care and Quality Improvement in Perioperative Neuroscience

Abstract

Value-based care and quality improvement are related concepts used to measure and improve clinical care. Value-based care represents the relationship between the incremental gain in outcome for patients and cost efficiency. It is achieved by identifying outcomes that are important to patients, codesigning solutions using multidisciplinary teams, measuring both outcomes and costs to drive further improvements, and developing partnerships across the health system. Quality improvement is focused on process improvement and compliance with best practice, and often uses "Plan-Do-Study-Act" cycles to identify, test, and implement change. Validated, standardized core outcome sets for perioperative neuroscience are currently lacking, but neuroanesthesiologists can consider using traditional clinical indicators, patient-reported outcomes measures, and perioperative core outcome measures. Several examples of bundled care solutions have been successfully implemented in perioperative neuroscience to increase value; for example, enhanced recovery for spine surgery, delirium reduction pathways, and same-day discharge craniotomy. This review proposes potential individualand system-based solutions to address barriers to value-based care and quality improvement in perioperative neuroscience.

Quality: A Dynamic and Essential Component of Health Care Services

“…5 Value is a subjective term, but for clinicians, it is measured by the outcomes achieved and not by the volume of services delivered or balance sheets. 6 The forces determining the meaning of outcomes or value are always at play, though presumably, everyone wants more money and healthier patients. Neuroscience-specific patient-reported outcome measures are small in number and rarely aggregated.…”

“…7 In addition, neuroscience patients present a particular challenge due to the underlying functional and cognitive changes that are present before and expected after surgery. 6 Therefore, to define value in perioperative neuroscience, objective measures of functional outcomes with patient-reported measures are required. Enhanced recovery for spine surgery, same-day discharge after craniotomy, and delirium reduction pathways are examples of multidisciplinary collaborations and process-oriented innovations to achieve better health care outcomes, quality, and value.…”

“…Achieving high value for patients must become the overarching goal of health care delivery, with value defined as the outcomes achieved per dollar spent 5. Value is a subjective term, but for clinicians, it is measured by the outcomes achieved and not by the volume of services delivered or balance sheets 6. The forces determining the meaning of outcomes or value are always at play, though presumably, everyone wants more money and healthier patients.…”

A New Look for the Journal of Neurosurgical Anesthesiology

“…Other new areas of interest for JNA include quality improvement and health service delivery as it relates to perioperative neuroscience. 6 In 1991, a fruitful and enduring partnership began when JNA became the official journal of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC). Importantly, the recent expansion of JNA content has not occurred in isolation but alongside changes in SNACC as the society adapted and evolved to reflect changes in the clinical practice and research interests of its members.…”

“…The authors also highlight key areas for future research in perioperative brain health and the need for multi professional involvement in such research, including the importance of involvement of neuroanesthesiologists and neurointensivists. Other new areas of interest for JNA include quality improvement and health service delivery as it relates to perioperative neuroscience 6…”