Quality assurance in neurosurgery: United States concepts

At present, quality assurance in United States neurosurgery is based primarily on neurosurgeons meeting requirements for certification by the American Board of Neurological Surgery and residency training programs meeting requirements for approval by the neurosurgical Residency Review Committee. These organizations, plus a number of other private, autonomous, physician directed groups have assumed responsibility for assuring neurosurgical quality. There are, however, no reliable data that such processes are effective and it is likely that neurosurgical quality assurance will move toward outcomes based documentation in the future. This article presents a brief review of the concepts of quality assurance and assessment as they are applied in the healthcare system of the United States. A more detailed review of the process of neurosurgical credentialing is also presented and a paradigm for evaluating and improving neurosurgical quality is proposed. It must be clearly stated that the opinions expressed in this article are those of the author and do not represent the official position of any neurosurgical organization.