title: Determining the elements of procedural quality.
abstract: OBJECTIVE
  The definition and determination of quality health care is an important topic. The purpose of this study was to develop a longitudinal method to define a quality procedure by creating a formal approach to pre- and postoperative outcomes documentation. The authors worked to define quality outcomes by first documenting the patient's condition. Goals were determined together by the surgeon and the patient and then were evaluated to see if those goals were met.
  
  
  METHODS
  The population consisted of cancer patients with newly diagnosed metastatic brain disease who were scheduled to undergo stereotactic radiosurgery. Surgeons recorded perioperatively objective information related to preoperative goals, clinical findings, surgical performance and/or error, and whether goals were met. In addition, patients completed pre- and postprocedure questionnaires (Rand 36-Item Short-Form Health Survey 1.0 [SF-36]).
  
  
  RESULTS
  Procedural goals, defined as completing radiosurgery without error or complication and same-day discharge, were met in all patients. The clinically predetermined goal of tumor palliation was met in all but 1 patient at follow-up. The SF-36 scores remained stable except for the general health domain, which was lower (p = 0.006).
  
  
  CONCLUSIONS
  Procedural goals can be defined and objectively measured serially. The authors think that quality care can be defined as a process that achieves predefined goals without significant error and maintains or improves health.
authors: Department of Neurological Surgery, University of Pittsburgh, PA, USA.
authors: Oren
authors: O
authors: Berkowitz
authors: Kristen
authors: K
authors: Jones
authors: L Dade
authors: LD
authors: Lunsford
authors: Douglas
authors: D
authors: Kondziolka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery*; D005260:Female; D019538:Health Care Surveys; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D016634:Radiosurgery / Q000592:standards*; D016896:Treatment Outcome