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Evaluating innovation. Part 2: Development in neurosurgery.

Zane Schnurman¹, Douglas Kondziolka¹

¹Department of Neurosurgery, NYU Langone Medical Center, New York, New York.

Journal of Neurosurgery

|August 8, 2015

Summary

Researchers developed a new model to quantify surgical innovation acceptance. This "progressive scholarly acceptance" (PSA) metric identifies factors influencing neurosurgical progress and categorizes development into three archetypes.

Keywords:

BCNU = 1,3-bis(2-chloroethyl)-l-nitrosourea CMS = Centers for Medicare and Medicaid Services DBS = deep brain stimulation ET = essential tremor GDC = Guglielmi detachable coil LCD = local coverage determination PSA = progressive scholarly acceptance RCT = randomized controlled trial SRS = stereotactic radiosurgery TN = trigeminal neuralgia VNS = vagus nerve stimulation innovation model neurosurgery science

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Area of Science:

Medical Innovation
Surgical Development
Health Services Research

Background:

Medical advance evaluation reform is advocated by patients, practitioners, payers, and regulators.
Surgery lacks a standardized developmental pathway, making acceptance unclear.
A novel model quantifies the process of surgical procedure acceptance.

Purpose of the Study:

To develop a model quantifying the acceptance of surgical procedures.
To identify common archetypes and influences on neurosurgical progress.
To analyze factors affecting the transition from idea inception to community acceptance.

Main Methods:

Evaluated literature for seven neurosurgical procedures developed in the last 15-25 years.
Defined
progressive scholarly acceptance
(PSA) as the endpoint for community acceptance.
Assessed report characteristics, patient numbers, study design, and authoring groups up to the PSA point.

Main Results:

Procedural accessibility (disease rarity, regulations, cost) influenced report numbers, patient studies, and contributing author groups.
The feasibility of randomized controlled trials impacted study design.
Three developmental archetypes of surgery were characterized based on these factors.

Conclusions:

Common surgical development archetypes can be described by factors influencing investigation, data, and acceptance.
The proposed model and terminology can inform future procedural development and regulation of surgical innovation.