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Developing a Value-Based Approach to Outcome Reporting in Pediatric Surgery
Lucshman Raveendran1, Martin Koyle2, Mary Brindle3
1Faculty of Medicine and Institute of Health Policy, Management and Evaluation University of Toronto, Toronto, ON.
Insights
Current quality measures for pediatric surgery are inadequate. New, holistic well-being metrics are needed to better assess and improve care for children undergoing surgical procedures.
Area of Science:
- Pediatric Surgery
- Healthcare Quality Improvement
- Value-Based Healthcare
Background:
- Pediatric surgical populations in high-resource settings primarily include low-risk patients, leading to low incidence of critical outcomes.
- Traditional quality measurement tools are insufficient for sensitive assessment due to outcome rarity.
- There is a need for scalable solutions and holistic measures of child well-being to improve pediatric surgical care.
Purpose of the Study:
- To discuss opportunities for enhanced performance measurement in pediatric surgery.
- To propose a value-based framework for measuring patient and family outcomes throughout the care cycle.
- To identify new avenues for benchmarking and improving the quality of pediatric surgical care.
Main Methods:
- Literature review and conceptual framework development.
- Discussion of a value-based approach to performance measurement.
- Analysis of patient and family outcomes across the full care continuum.
Main Results:
- Current quality metrics are inadequate for sensitive measurement in pediatric surgery.
- A value-based framework can identify and measure key patient and family outcomes.
- Enhanced measures can support the development and evaluation of surgical innovations.
Conclusions:
- Holistic measures of child well-being are essential for effective quality assessment in pediatric surgery.
- A value-based framework offers a path toward more sensitive and comprehensive performance measurement.
- Improved measurement strategies can drive innovation in pediatric surgical care delivery.
Abstract:
The population that undergoes pediatric surgical procedures in high-resource settings such as Canada primarily comprises healthy patients who undergo low-risk, elective surgeries and fewer higher-risk patients who require more complex surgeries. Given this variability, there is a relatively low incidence of traditionally measured "critical" outcomes within any single pediatric surgical system or even pediatric surgical subspecialty, rendering the currently available quality measurement tools inadequate to provide sensitive measures of quality. In an era when scalable solutions are required to improve health outcomes across entire populations, there is an urgent need for more holistic measures of a child's well-being to benchmark and measure changes in quality of care. This article discusses opportunities for enhanced performance measurement in pediatric surgery using a value-based framework to identify and measure patient and family outcomes of importance over the full care cycle, from initial presentation through surgery and recovery to sustainability of health. In suggesting new avenues for performance measurement, we highlight how these measures can be used to develop, evaluate and refine surgical system innovations such as bundled care pathways and perioperative care homes.
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