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Quality Measures in Upper Limb Surgery.

Robin N Kamal1, David Ring2, Edward Akelman3

  • 1Department of Orthopaedic Surgery, Stanford University, Redwood City, California rnkamal@stanford.edu.

The Journal of Bone and Joint Surgery. American Volume
|March 18, 2016
PubMed
Summary
This summary is machine-generated.

Existing upper limb quality measures heavily favor process measures over structure or outcome measures. This suggests a need for developing more comprehensive quality indicators in upper limb surgery.

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Area of Science:

  • Orthopedic Surgery
  • Healthcare Quality Improvement
  • Health Services Research

Background:

  • Quality measures are increasingly linked to financial incentives in healthcare.
  • Existing quality measures for the upper limb were reviewed to assess their representation across structure, process, and outcome domains.
  • The study tested the hypothesis of equal representation among these measure types.

Purpose of the Study:

  • To systematically review and characterize existing quality measures for upper limb surgery.
  • To evaluate the distribution of quality measures across structure, process, and outcome categories.
  • To identify gaps in quality measure development for upper limb care.

Main Methods:

  • Systematic literature review of multiple databases (MEDLINE/PubMed, Embase, Google Scholar) and guideline sources.
  • Inclusion of quality measures from professional societies and government reporting systems.
  • Categorization of measures by type (structure, process, outcome) and alignment with the National Quality Strategy.

Main Results:

  • A total of 134 quality measures for the upper limb were identified.
  • The vast majority (98%) were process measures, with only 2% being outcome measures.
  • Process measures primarily focused on effective clinical care (90%), with limited representation of other National Quality Strategy priorities.

Conclusions:

  • There is a significant need to develop more structure and outcome measures for upper limb surgery.
  • Gaps exist in measures related to patient engagement, public health, safety, care coordination, and resource efficiency.
  • The current emphasis on process measures may not be optimal for improving upper limb surgery quality due to limited evidence of their impact.