Jennifer Bido1,2, Roya Ghazinouri1, Jamie E Collins1,2, Desirée Diez Portela3, Luis Alcantara3, Thomas S Thornhill1,2, Jeffrey N Katz1,2,4. 1. Orthopaedic and Arthritis Center for Outcomes Research (J.B., R.G., J.E.C., T.S.T., and J.N.K.), Center for Healthcare Delivery Sciences, Department of Medicine (R.G.) Department of Orthopaedic Surgery (J.E.C., T.S.T., and J.N.K.). 2. Harvard Medical School, Boston, Massachusetts. 3. Departments of Project Management (D.D.P.) and Orthopaedic Surgery (L.A.), Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic. 4. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Abstract
BACKGROUND: Medical missions to low and middle-income countries are increasingly frequent, with an estimated 6,000 trips sponsored by U.S. organizations accounting for approximately 200,000 surgical cases and $250 million in costs annually. However, these missions have received little critical evaluation. This paper describes the research program Operation Walk (Op-Walk) Boston, and proposes an evaluation model for similar surgical missions. METHODS: We propose an evaluation model, borrowing from the work of Donabedian and enriched by evidence from our research program. The model calls for evaluation of the salient contextual factors (culture and beliefs), system management (structure, process, and outcomes), and sustainability of the program's interventions. We used these domains to present findings from the quantitative and qualitative research work of Op-Walk Boston. RESULTS: Op-Walk's qualitative research findings demonstrated that cultural factors are important determinants of patients' perceptions of arthritis etiology, physical activity patterns, and treatment preferences. Quantitative assessments documented that Dominican patients had worse lower-extremity functional status (mean Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function score of 33.6) and pain preoperatively than patients undergoing total hip or knee replacement in the U.S. (WOMAC function score of 43.3 to 54), yet they achieved excellent outcomes (50-point improvement), comparable to those of their U.S. counterparts. Assessments of the quality and sustainability of the Op-Walk program showed that the quality of care provided by Op-Walk Boston meets Blue Cross Blue Shield Centers of Excellence (Blue Distinction) criteria, and that sustainable changes were transferred to the host hospital. CONCLUSIONS: Our proposed model offers a method for formal assessment of medical missions that addresses the call for evidence of their merit. We suggest that surgical missions adopt quantitative and qualitative strategies to document their impact, identify areas of improvement, and justify program continuation, growth, and support.
BACKGROUND: Medical missions to low and middle-income countries are increasingly frequent, with an estimated 6,000 trips sponsored by U.S. organizations accounting for approximately 200,000 surgical cases and $250 million in costs annually. However, these missions have received little critical evaluation. This paper describes the research program Operation Walk (Op-Walk) Boston, and proposes an evaluation model for similar surgical missions. METHODS: We propose an evaluation model, borrowing from the work of Donabedian and enriched by evidence from our research program. The model calls for evaluation of the salient contextual factors (culture and beliefs), system management (structure, process, and outcomes), and sustainability of the program's interventions. We used these domains to present findings from the quantitative and qualitative research work of Op-Walk Boston. RESULTS: Op-Walk's qualitative research findings demonstrated that cultural factors are important determinants of patients' perceptions of arthritis etiology, physical activity patterns, and treatment preferences. Quantitative assessments documented that Dominican patients had worse lower-extremity functional status (mean Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function score of 33.6) and pain preoperatively than patients undergoing total hip or knee replacement in the U.S. (WOMAC function score of 43.3 to 54), yet they achieved excellent outcomes (50-point improvement), comparable to those of their U.S. counterparts. Assessments of the quality and sustainability of the Op-Walk program showed that the quality of care provided by Op-Walk Boston meets Blue Cross Blue Shield Centers of Excellence (Blue Distinction) criteria, and that sustainable changes were transferred to the host hospital. CONCLUSIONS: Our proposed model offers a method for formal assessment of medical missions that addresses the call for evidence of their merit. We suggest that surgical missions adopt quantitative and qualitative strategies to document their impact, identify areas of improvement, and justify program continuation, growth, and support.
Authors: Kyle E Dempsey; Jamie E Collins; Roya Ghazinouri; Luis Alcantara; Thomas S Thornhill; Jeffrey N Katz Journal: Rheumatology (Oxford) Date: 2013-06-07 Impact factor: 7.580
Authors: Derek S Stenquist; Scott A Elman; Aileen M Davis; Laura M Bogart; Sarah A Brownlee; Edward S Sanchez; Adianez Santiago; Roya Ghazinouri; Jeffrey N Katz Journal: Arthritis Care Res (Hoboken) Date: 2015-01 Impact factor: 4.794
Authors: Daniel A Hu; Ryan E Harold; Emanuelle de Cândida Soares Pereira; Erika Trindade Cavalcante; Maria Paula Mariz da Silveira Barros; Synara Nunes Medeiros de Souza; Julio Souza; Victoria A Brander; S David Stulberg Journal: Arthroplast Today Date: 2021-07-09