"EVIDENCE-BASED AND OUTCOMES DRIVEN" ^sm

At MUSC we strive to practice neurosurgery that is based on the best available scientific evidence regarding the diagnosis and treatment of neurosurgical disease. However, knowing what is best is not enough. We also strive to monitor our results of treatment and modify our treatment plans so as to continuously improve those outcomes.

Evidence-based medicine has become a theme of the practice of medicine as we move into the 21st century. It is not as easy as it sounds. The human being is the most complex organism we know of, and we don't have the plans or the instruction manual. The gathering of scientific evidence to determine best diagnostic and treatment methods is difficult and requires the cooperation of patients and doctors willing to try new things in a scientific way. When this is done successfully, we all benefit. The evidence thus obtained helps us determine best treatment for everyone in the future. In the absence of such evidence, your doctor must apply principles and logic to make an educated guess at the best treatment. For many situations in neurosurgery this is what must be done, as scientific clinical evidence is relatively rare in a small subspecialty such as neurosurgery.

Measuring outcome is also more difficult than it sounds. It is easy to tell if a person lives or dies following an operation, but, fortunately, death following neurosurgical operations is rare. Many neurosurgical operations are done to relieve pain or enhance function. The result is "subjective". In other words, the result is measured by the patient's own understanding of the outcome. Obviously, people have different ideas of what a "successful" outcome may be. People with different pain thresholds may have identical technical results but different perceptions of the "success" of the procedure. Therefore, we use a number of outcome measurement "tools" that have been tested and shown to provide reliable assessment of outcome in a variety of situations. Most of these "tools" are in the form of questionnaires that we incorporate into patient evaluations before and after surgery. In addition, for every procedure done we track a small number of "objective" measures that form a "report card" that can be followed over time to track improvement efforts.

The end result of following the principles of evidence-based medicine and routine outcome assessment is the continuous improvement in outcome: better care for our patients.