Saurabh Saluja1,2, Swagoto Mukhopadhyay1,3, Julia R Amundson1,4, Allison Silverstein1, Jessica Gelman4, Hillary Jenny1,5, Yihan Lin1,6, Anthony Moccia7, Ramy Rashad8, Rachita Sood1,4, Nakul P Raykar1,9, Mark G Shrime1. 1. Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA, USA. 2. Department of Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY, USA. 3. Department of Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT, USA. 4. Department of Education, Miller School of Medicine, University of Miami, 1600 NW 10th Avenue #1140, Miami, FL, USA. 5. Icahn School of Medicine at Mt. Sinai, 1 Gustav Levy Place, New York, NY, USA. 6. Department of Surgery, University of Colorado, 12631 E 17th Avenue, Aurora, CO, USA. 7. Harvard Initiative on Global Health Quality, Harvard Global Health Institute, 42 Church St, Cambridge, MA, USA. 8. Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, USA. 9. Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis St, Boston, MA, USA.
Abstract
PURPOSE: Quality of care is an emerging area of focus in the surgical disciplines. However, much of the emphasis on quality is limited to high-income countries. To address this gap, we conducted a systematic review of the literature on the quality of essential surgical care in low- and middle- income countries (LMIC). DATA SOURCES: We searched PubMed, Cinahl, Embase and CAB Abstracts using three domains: quality of care, surgery and LMIC. STUDY SELECTION: We limited our review to studies of essential surgeries that pertained to all three search domains. DATA EXTRACTION: We extracted data on study characteristics, type of surgery and the way in which quality was studied. RESULTS OF DATA SYNTHESIS: 354 studies were included. 281 (79.4%) were single-center studies and nearly half (n = 169, 46.9%) did not specify the level of facility. 207 studies reported on mortality (58.47%) and 325 reported on a morbidity (91.81%), most commonly surgical site infection (n = 190, 53.67%). Of the Institute of Medicine domains of quality, studies were most commonly of safety (n = 310, 87.57%) and effectiveness (n = 180, 50.85%) and least commonly of equity (n = 21, 5.93%). CONCLUSION: We find that while there are numerous studies that report on some aspects of quality of care, much of the data is single center and observational. Additionally, there is variability on which outcomes are reported both within and across specialties. Finally, we find under-reporting of parameters of equity and timeliness, which may be critical areas for research moving forward.
PURPOSE: Quality of care is an emerging area of focus in the surgical disciplines. However, much of the emphasis on quality is limited to high-income countries. To address this gap, we conducted a systematic review of the literature on the quality of essential surgical care in low- and middle- income countries (LMIC). DATA SOURCES: We searched PubMed, Cinahl, Embase and CAB Abstracts using three domains: quality of care, surgery and LMIC. STUDY SELECTION: We limited our review to studies of essential surgeries that pertained to all three search domains. DATA EXTRACTION: We extracted data on study characteristics, type of surgery and the way in which quality was studied. RESULTS OF DATA SYNTHESIS: 354 studies were included. 281 (79.4%) were single-center studies and nearly half (n = 169, 46.9%) did not specify the level of facility. 207 studies reported on mortality (58.47%) and 325 reported on a morbidity (91.81%), most commonly surgical site infection (n = 190, 53.67%). Of the Institute of Medicine domains of quality, studies were most commonly of safety (n = 310, 87.57%) and effectiveness (n = 180, 50.85%) and least commonly of equity (n = 21, 5.93%). CONCLUSION: We find that while there are numerous studies that report on some aspects of quality of care, much of the data is single center and observational. Additionally, there is variability on which outcomes are reported both within and across specialties. Finally, we find under-reporting of parameters of equity and timeliness, which may be critical areas for research moving forward.
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Authors: Shehnaz Alidina; Pritha Chatterjee; Noor Zanial; Sakshie Sanjay Alreja; Rebecca Balira; David Barash; Edwin Ernest; Geofrey Charles Giiti; Erastus Maina; Adelina Mazhiqi; Rahma Mushi; Cheri Reynolds; Meaghan Sydlowski; Florian Tinuga; Sarah Maongezi; John G Meara; Ntuli A Kapologwe; Erin Barringer; Monica Cainer; Isabelle Citron; Amanda DiMeo; Laura Fitzgerald; Hiba Ghandour; Magdalena Gruendl; Augustino Hellar; Desmond T Jumbam; Adam Katoto; Lauren Kelly; Steve Kisakye; Salome Kuchukhidze; Tenzing N Lama; Gopal Menon; Stella Mshana; Chase Reynolds; Hannington Segirinya; Dorcas Simba; Victoria Smith; Steven J Staffa; Christopher Strader; Leopold Tibyehabwa; Alena Troxel; John Varallo; Taylor Wurdeman; David Zurakowski Journal: BMJ Qual Saf Date: 2021-02-05 Impact factor: 7.035