John D. Rolston, MD, PhD, Editor

Seunggu J. Han, MD, Editor

Andrew T. Parsa, MD, PhD Editor

Unlike many other disciplines in medicine, QI is intimately associated with governing and regulatory systems. Drivers of QI have long included physician-led systems like the American Medical Association and the American College of Surgeons, but the US Federal Government is also highly invested, predominantly after the creation of Medicare and Medicaid in 1965 made it economically critical to do so. More recently, with the passage of the Affordable Care Act in 2010, the importance of QI has been repeatedly reiterated.

In a 2012 report to Congress, the “Triple Aim” was outlined by the Department of Health and Human Services to define the goals for modern health care QI:

• 1.
  

  “Better Care: Improve the overall quality of care, by making health care more patient-centered, reliable, accessible, and safe.”

  
  
• 2.
  

  “Healthy People/Healthy Communities: Improve the health of the US population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.”

  
  
• 3.
  

  “Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.”

Because of the government’s involvement, engagement in QI initiatives is no longer optional for providers of health care. Reimbursements are being tied to quality measures through Value-Based Purchasing, Pay-for-Performance, and the creation of Accountable Care Organizations. Data on quality of care provided by individuals and institutions are becoming available to patients. Participation in registries and QI programs is also now tied to reimbursements from the Centers for Medicare and Medicaid Services.

Because of these changes, it is more important than ever for neurosurgeons to understand the process of QI, to see how it can ultimately improve the health of their patients, and to engage in critically evaluating the evidence behind quality measures and processes. This issue of Neurosurgery Clinics of North America is an attempt to gather much of this information in a single resource, with a focus on QI as it relates to neurosurgeons and neurosurgery departments. Our hope is that the following articles provide concise starting points on the primary issues of QI in neurosurgery.

The editors would like to acknowledge Catherine Y. Lau, MD for her contributions to this article.