The History of Quality Assessment in Spine Care

Abstract

Quality assessment in spine care has undergone a necessary transition over the last several decades. Initially, quality was measured by clinician-centered approaches that relied on clinician-centered metrics such as length of hospital stay, quality of fusion, need for blood transfusion, or amount of deformity correction. This narrow focus of quality assessment did not consider the perspective of the patient and therefore did not grasp the burden of spine disease from a societal perspective. Clinicians were soon able to understand the need to model quality from the perspective of the patient and society, and therefore the development of patient-related outcome (PRO) tools was commenced. Advancement in the application of PRO instruments continues. Simultaneously, given the current healthcare economic crisis, there is a greater push to create value in spine care: to provide the highest quality care in the most cost-efficient manner. The complex ideology of value and how it is modeled is a burgeoning topic in spine care. The current methods for assessing value have opportunity for improvement and may attain more sophistication and refinement in the future.