Clinical Validation of Quality Improvements Using the Six Sigma Concept: A Case Study for Deep Brain Stimulation in Parkinson's Disease

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

Abstract

Background: The Six Sigma concept allows for the evaluation of quality changes after the implementation of new technical equipment or adjustment of perioperative procedures. Exemplarily, we applied this method for quality assessment in deep brain stimulation surgery (DBS) for Parkinson's disease. Methods: The medical procedure and possible errors were registered. Then, 6 critical-To-quality characteristics regarding clinical outcome, surgical precision, and the surgical process were measured. The surgical procedure was then optimized in 2 steps, and its measurement, along with the analysis, was repeated twice. Results: By optimizing perioperative settings, the operation time could be reduced, and the precision of the lead placement could be increased. Clinical outcome, as measured by improvement in UPDRS-III, IV, and reduction of medication could also be improved with smaller required stimulation voltage. With directional leads considerable reduction of medication was achieved in 97% of patients (σ-value 3.39) compared to 83.7% (σ-value 2.53) with nondirectional leads. Conclusion: This study shows that the Six Sigma concept is a suitable quality tool to analyze and improve treatment quality of complex medical procedures such as lead positioning in DBS surgery in clinical routine. Our results suggest that directional leads in subthalamic nucleus DBS may have a favorable impact on patients' outcome.

Details

OriginalspracheEnglisch
Seiten (von - bis)195-201
Seitenumfang7
FachzeitschriftStereotactic and functional neurosurgery
Jahrgang97
Ausgabenummer3
PublikationsstatusVeröffentlicht - 1 Nov. 2019
Peer-Review-StatusJa

Externe IDs

PubMed 31553992
ORCID /0000-0002-6603-5375/work/148606653

Schlagworte

ASJC Scopus Sachgebiete

Schlagwörter

  • Deep brain stimulation, Parkinson's disease, Quality improvement, Quality measurement, Six Sigma