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Defining Quality in Hand Surgery From the Patient's Perspective: A Qualitative Analysis
Sara L Eppler1, Sanjeev Kakar2, Nicole Sheikholeslami1
1Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
The Journal of Hand Surgery
|July 23, 2018
Summary
Patients define high-quality hand surgery care by preparation, functional recovery, managing challenges, and addressing costs. Current quality measures miss key patient-centered aspects, highlighting a need for improved patient-reported outcomes in hand surgery.
Area of Science:
- Patient-centered care
- Health services research
- Qualitative research methodology
Background:
- Traditional quality measures in healthcare are often developed from a provider's perspective.
- This can lead to a misalignment between healthcare delivery and patient values and preferences.
- Patient input is crucial for developing meaningful quality measures.
Purpose of the Study:
- To explore how patients with hand problems define high-quality care.
- To understand the patient experience in hand surgery, including knowledge gaps and the surgical process.
- To identify patient-centered themes for high-quality hand surgery.
Main Methods:
- A qualitative study involving a patient steering committee (n=10) to refine survey questions.
- Distribution of an open-ended questionnaire to 99 hand surgery patients at two tertiary care institutions.
- Thematic analysis of patient responses by two independent reviewers to identify quality of care themes.
Main Results:
- Four key themes emerged: patient preparedness and information, regaining hand function without pain, managing recovery challenges (physical and psychological), and addressing financial/logistical burdens.
- Patient-identified aspects of high-quality care are not fully captured by existing quality measures.
- Key areas include patient education, system navigation, recovery support, and cost considerations.
Conclusions:
- Current quality measures for hand surgery do not adequately reflect patient-identified high-quality care.
- Patient-derived themes offer a foundation for developing future patient-centered quality measures.
- Focusing on patient-valued aspects like education, system navigation, recovery, and cost can improve healthcare delivery.