Focused ReviewValue-based Care and Quality Improvement in Perioperative NeuroscienceLuoma, Astri M.V. MBChB, FRCA, FFICM*,†; Flexman, Alana M. MD, MBA, FRCPC‡,§,∥ Author Information *Department of Neuroanaesthesia and Neurocritical Care, National Hospital for Neurology and Neurosurgery, University College London Hospitals, NHS Foundation Trust, Queen Square †Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK ‡Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia §Department of Anesthesia, St. Paul’s Hospital, Providence Health Care ∥Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada A.M.F. is an associate editor at the Journal of Neurosurgical Anesthesiology and receives consultant fees from UpToDate. A.M.V.L. is on the Editorial Board for the Journal of Neurosurgical Anesthesiology. Address correspondence to: Alana M. Flexman, MD, MBA, FRCPC. E-mail: [email protected]. Journal of Neurosurgical Anesthesiology 34(4):p 346-351, October 2022. | DOI: 10.1097/ANA.0000000000000864 Buy Metrics Abstract Value-based care and quality improvement are related concepts used to measure and improve clinical care. Value-based care represents the relationship between the incremental gain in outcome for patients and cost efficiency. It is achieved by identifying outcomes that are important to patients, codesigning solutions using multidisciplinary teams, measuring both outcomes and costs to drive further improvements, and developing partnerships across the health system. Quality improvement is focused on process improvement and compliance with best practice, and often uses “Plan-Do-Study-Act” cycles to identify, test, and implement change. Validated, standardized core outcome sets for perioperative neuroscience are currently lacking, but neuroanesthesiologists can consider using traditional clinical indicators, patient-reported outcomes measures, and perioperative core outcome measures. Several examples of bundled care solutions have been successfully implemented in perioperative neuroscience to increase value; for example, enhanced recovery for spine surgery, delirium reduction pathways, and same-day discharge craniotomy. This review proposes potential individual- and system-based solutions to address barriers to value-based care and quality improvement in perioperative neuroscience. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.