Purpose
Quality measures are used to evaluate health care delivery. They are traditionally
developed from the physician and health system viewpoint. This approach can lead to
quality measures that promote care that may be misaligned with patient values and
preferences. We completed an exploratory, qualitative study to identify how patients
with hand problems define high-quality care. Our purpose was to develop a better understanding
of the surgery and recovery experience of hand surgery patients, specifically focusing
on knowledge gaps, experience, and the surgical process.
Methods
A steering committee (n = 10) of patients who had previously undergone hand surgery
reviewed and revised an open-ended survey. Ninety-nine patients who had undergone
hand surgery at 2 tertiary care institutions completed the open-ended, structured
questionnaire during their 6- to 8-week postoperative clinic visit. Two reviewers
completed a thematic analysis to generate subcodes and codes to identify themes in
high-quality care from the patient’s perspective.
Results
We identified 4 themes of high-quality care: (1) Being prepared and informed for the
process of surgery, (2) Regaining hand function without pain or complication, (3)
Patients and caregivers negotiating the physical and psychological challenges of recovery,
and (4) Financial and logistical burdens of undergoing hand surgery.
Conclusions
Multiple areas that patients identify as representing high-quality care are not reflected
in current quality measures for hand surgery. The patient-derived themes of high-quality
care can inform future patient-centered quality measure development.
Clinical relevance
Efforts to improve health care delivery may have the greatest impact by addressing
areas of care that are most valued by patients. Such areas include patient education,
system navigation, the recovery process, and cost.
Key words
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Article info
Publication history
Published online: July 18, 2018
Footnotes
Received for publication December 12, 2017; accepted in revised form May 29, 2018.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
