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[Patient reported process and outcome indicators for clinical audit in short-stay surgery]
Eva Maria Bitzer1, Stefan Nickel, Christoph Lorenz
1ISEG - Institut für Sozialmedizin, Epidemiologie und Gesundheitssystemforschung, Hannover. bitzer@iseg.org
Background:
Based on patient-reported process and outcome indicators of care, a system for quality improvement in short-stay surgery was developed for hernia repair and cholecystectomy. The study aimed to test the feasibility and validity of the system.
Methods:
In two centres for short-stay surgery all patients referred for hernia repair or cholecystectomy were surveyed between August 1999 and January 2002 (T0: preoperative, T1: 14 days post-OP, T2: 6 months post-OP). At T0 and T1 survey instruments were given to patients in the participating centres, at T2 the survey instruments were mailed. Of 342 hernia patients and 250 cholecystolithiasis patients at T0, responses from only 54.1% (hernia) and 63.4% (cholecystolithiasis) were available at T2. Non-response predominantly occurred between T0 and T1. Patients reported on satisfaction with care (FKKP), health-related quality of life (HRQL; SF-36), disease-specific symptoms (symptom checklists), treatment satisfaction and other indicators.
Results:
Satisfaction with care was quite high. The process indicator of the lowest satisfaction was the provision of competencies to deal with problems at home after discharge at home. At T2 21.1% (hernia) and 66.2% (cholecystolithiasis) reported no complications. Both symptom checklists reflect the positive postoperative course (effect size T0-T2: 1.16 and 0.75). From a T0 level lower than the German reference population (six of the eight SF-36 subscales) HRQL reaches or exceeds the population norms at T2.
Conclusion:
In general, both the proposed proceedings and the instrument were applicable and feasible. Patient-oriented quality indicators contain additional information on processes and outcomes of care. However, the participating centres were not fully prepared to spend the extra effort necessary to organise such a longitudinal survey. To decrease non-response between T0 and T1, survey instruments should be mailed at T1 (instead of handing them over to patients during their postoperative visit).
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