Abstract
A common theme of medicine in the modern era is the desire to iterate and improve. While science and medicine charge forward to improve our ability to treat disease, no discussion about where we are headed is complete without first considering where we have been. In the chapters that follow, authors will lay out the present and future of addressing the quality question in spinal surgery. In the present chapter, we discuss the intellectual history of this question. First, we consider the historical development of semiquantitative metrics for assessing outcomes in spinal surgery, from the Massachusetts General Hospital Anatomic Economic Functional Rating System to the Prolo scale. We then consider the parallel development of a medicolegal framework to assess quality of patient care, from Medicare’s abortive Utilization Review Committees (URCs) to the modern Physician Quality Reporting System (PQRS). We close by considering who these structures affect; discuss the complex system of patients, payers (both public and private), and greater society; and find unique incentives for ensuring quality care at each level. Finally, we briefly look forward to new tools that will aid healthcare professionals in ensuring high-quality care.
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Hariri, O.R., Takayanagi, A., Florence, T.J., Wali, A.R. (2019). Historical Aspects of Quality in Healthcare. In: Ratliff, J., Albert, T., Cheng, J., Knightly, J. (eds) Quality Spine Care. Springer, Cham. https://doi.org/10.1007/978-3-319-97990-8_1
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