title: Quality Programs in Neurosurgery: The Memorial Hermann/University of Texas Experience.
abstract: The importance of outcome measures is steadily increasing due to the rise of "pay for performance" and the advent of population health. In 2007, a quality initiative was started due to poor performance on rankings such as the University Health Consortium (UHC) report card. Inherent to all such efforts are common challenges: how to engage the providers; how to gather and ensure the accuracy of the data; how to attribute results to individuals; how to ensure permanent improvements. After analysis, a strategy was developed that included an initial focus on 3 metrics (mortality, infection rates, and complications), leadership from practicing neurosurgeons, protocol development and adherence, and subspecialization. In addition, it was decided that the metrics would initially apply to attending physicians only, but that the entire team would need to be involved. Once the fundamental elements were established, the process could be extended to other measures and providers. To support this effort, special information system tools were developed and a support team formed. As the program matured, measured outcomes improved and more metrics were added (to a current total of 48). For example, UHC mortality ratios (observed over expected) decreased by 75%. Infection rates decreased 80%. The program now involves all trainee physicians, advanced practice providers, nurses, and other staff. This paper describes the design, implementation, and results of this effort, and provides a practical guide that may be useful to other groups undertaking similar initiatives.
authors.affiliation: Department of Neurosurgery, The Uni-versity of Texas Medical School at Hous-ton, Houston, Texas.
authors.forename: Dong H
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Memorial Hermann Healthcare System, Houston, Texas.
authors.forename: Miriam
authors.initials: M
authors.lastname: Morales
authors.affiliation: Memorial Hermann Healthcare System, Houston, Texas.
authors.forename: Rahil
authors.initials: R
authors.lastname: Tai
authors.affiliation: Department of Neurosurgery, The Uni-versity of Texas Medical School at Hous-ton, Houston, Texas.
authors.forename: Georgene
authors.initials: G
authors.lastname: Hergenroeder
authors.affiliation: Memorial Hermann Healthcare System, Houston, Texas.
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.affiliation: Department of Neurosurgery, The Uni-versity of Texas Medical School at Hous-ton, Houston, Texas.
authors.forename: Joanna
authors.initials: J
authors.lastname: O'Leary
authors.affiliation: Memorial Hermann Healthcare System, Houston, Texas.
authors.forename: Nicole
authors.initials: N
authors.lastname: Harrison
authors.affiliation: Memorial Hermann Healthcare System, Houston, Texas.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Edquilang
authors.affiliation: Memorial Hermann Healthcare System, Houston, Texas.
authors.forename: Emily
authors.initials: E
authors.lastname: Paisley
authors.affiliation: Memorial Hermann Healthcare System, Houston, Texas.
authors.forename: Enedra
authors.initials: E
authors.lastname: Allen-McBride
authors.affiliation: Memorial Hermann Healthcare System, Houston, Texas.
authors.forename: Allison
authors.initials: A
authors.lastname: Murphy
authors.affiliation: Clear Path Solutions, Jamaica Plain, Massachusetts.
authors.forename: Justin
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of Neuro-surgery, Harvard Medical School, Cam-bridge, Massachusetts.
authors.forename: William
authors.initials: W
authors.lastname: Gormley
authors.affiliation: Memorial Hermann Healthcare System, Houston, Texas.
authors.forename: Amanda
authors.initials: A
authors.lastname: Spielman
mesh_terms: D006801:Humans; D009493:Neurosurgery; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D013781:Texas
keywords: Cost reduction; Length of stay; Metrics; Neurosurgery; Outcomes; Quality improvement