Isabelle Citron1, Saurabh Saluja2, Julia Amundson3, Rodrigo Vaz Ferreira4, David Ljungman5, Nivaldo Alonso6, Vitor Moutinho7, John G Meara8, Michael Steer3. 1. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Electronic address: Isabelle.citron@gmail.com. 2. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Surgery, Weill Cornell Medicine, New York, NY. 3. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. 4. Discipline of General Surgery, Universidade do Estado do Amazonas, Brasil. 5. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Sweden. 6. Department of Plastic Surgery, University of Sao Paulo, Brazil. 7. General Surgery Department, Hospital Militar de Área de São Paulo - HMASP, Brazilian Army. 8. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, MA.
Abstract
BACKGROUND: Worldwide efforts to improve access to surgical care must be accompanied by improvements in the quality of surgical care; however, these efforts are contingent on the ability to measure quality. This report describes a novel, evidence-based tool to measure quality of surgical care in low-resource settings. METHODS: We defined a widely applicable, multidimensional conceptual framework for quality. The suitability of currently available quality metrics to low-resource settings was evaluated. Then we developed new indicators with sufficient supportive evidence to complete the framework. The complete set of metrics was condensed into four collection sources and tools. RESULTS: The following 15 final evidence-based indicators were defined: (1) Safe structure: morbidity and mortality conference; (2) safe process: use of the safe surgery checklist; (3) (4) safe outcomes: perioperative mortality rate and proportion of cases with complications graded >2 on the Clavien-Dindo scale; (5) effective structure: provider density; (6) effective process: procedure rate; (7) effective outcome: rate of caesarean sections; (8) patient-centered process: use of informed consent; (9) patient-centered outcome: patient hospital satisfaction questionnaire; (10) timely structure: travel time to hospital; (11) timely process: time from emergency department presentation to non-elective abdominal surgery; (12) timely outcome: patient follow-up plan; (13) efficient process: daily operating room usage; (14) equitable outcome: comparative income of patients compared with population; and (15) proportion of patients facing catastrophic expenditure because of surgical care. CONCLUSION: This tool provides an evidence-based conceptual tool to assess the quality of surgical care in diverse low-resource settings.
BACKGROUND: Worldwide efforts to improve access to surgical care must be accompanied by improvements in the quality of surgical care; however, these efforts are contingent on the ability to measure quality. This report describes a novel, evidence-based tool to measure quality of surgical care in low-resource settings. METHODS: We defined a widely applicable, multidimensional conceptual framework for quality. The suitability of currently available quality metrics to low-resource settings was evaluated. Then we developed new indicators with sufficient supportive evidence to complete the framework. The complete set of metrics was condensed into four collection sources and tools. RESULTS: The following 15 final evidence-based indicators were defined: (1) Safe structure: morbidity and mortality conference; (2) safe process: use of the safe surgery checklist; (3) (4) safe outcomes: perioperative mortality rate and proportion of cases with complications graded >2 on the Clavien-Dindo scale; (5) effective structure: provider density; (6) effective process: procedure rate; (7) effective outcome: rate of caesarean sections; (8) patient-centered process: use of informed consent; (9) patient-centered outcome: patient hospital satisfaction questionnaire; (10) timely structure: travel time to hospital; (11) timely process: time from emergency department presentation to non-elective abdominal surgery; (12) timely outcome: patient follow-up plan; (13) efficient process: daily operating room usage; (14) equitable outcome: comparative income of patients compared with population; and (15) proportion of patients facing catastrophic expenditure because of surgical care. CONCLUSION: This tool provides an evidence-based conceptual tool to assess the quality of surgical care in diverse low-resource settings.
Authors: Chelsea Leversedge; Meghan McCullough; Luis Miguel Castro Appiani; Mùng Phan Đình; Robin N Kamal; Lauren M Shapiro Journal: World J Surg Date: 2022-10-10 Impact factor: 3.282
Authors: William Lodge; Gopal Menon; Salome Kuchukhidze; Desmond T Jumbam; Sarah Maongezi; Shehnaz Alidina; Boniface Nguhuni; Ntuli A Kapologwe; John Varallo Journal: Glob Health Action Date: 2020-12-31 Impact factor: 2.640
Authors: Sabrina Juran; Sanna Moren; Vatshalan Santhirapala; Lina Roa; Emmanuel Makasa; Justine Davies; Jose Miguel Guzman; Lars Hagander; Hampus Holmer; Mark G Shrime; Thomas G Weiser; John G Meara; Stefanie J Klug; David Ljungman Journal: Glob Health Sci Pract Date: 2021-12-21
Authors: Jose Valery; Haythem Helmi; Aaron Spaulding; Xinxuang Che; Gabriel Prada; Natalia Chamorro Pareja; Pablo Moreno-Franco; Fernando F Stancampiano Journal: BMJ Open Qual Date: 2019-10-01