Advertisement

Patient-Derived Framework for Quality in Hand Surgery: A Qualitative Analysis

Published:August 11, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.06.014

      Purpose

      Despite the growing attention to evaluating care from the patient perspective, the most common definitions and measurements of quality are currently defined by physicians and health systems. Studies have demonstrated how a lack of patient input can lead to discrepancies between patients’ and physicians’ assessments of quality and, subsequently, worse patient outcomes. Although quality measures are increasingly used in hand surgery, insufficient work has examined whether these quality measures align with what matters to patients. We completed a qualitative study to assess how patients define high-quality care through the pre-, peri-, and postoperative phases of care in hand surgery.

      Methods

      Based on our prior work, we created an open-ended interview guide and conducted semistructured interviews with 43 hand surgery patients at 5 tertiary-care institutions during various phases of care. We completed a thematic analysis to generate subcodes and open codes, to identify themes in high-quality care from the patient perspective.

      Results

      Patients defined high-quality care as a process of (1) setting and meeting clear expectations; (2) achieving functional goals after surgery; and (3) feeling comfortable with and cared for by the care team. We identified the following 4 patient-centered themes that contributed to high-quality care: (1) communication between the patient and care team through all phases of care; (2) efficient and accurate diagnosis and treatment; (3) satisfactory treatment outcomes and postsurgical experience; and (4) acceptable systemic aspects of care.

      Conclusions

      Efforts to improve health care delivery should include areas of care that are important to patients. Our results suggest that measuring aspects of care that often go without assessments, such as communication, can maximize care quality as defined by patients.

      Clinical relevance

      The themes identified in this study can inform efforts towards patient-centered quality measure development.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Greenhalgh J.
        • Gooding K.
        • Gibbons E.
        • et al.
        How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis.
        J Patient Rep Outcomes. 2018; 2: 42
        • Institute of Medicine (US)
        Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century.
        National Academies Press, 2001
        • Hand Surgery Quality Consortium
        Candidate quality measures for hand surgery.
        J Hand Surg Am. 2017; 42: 859-866.e3
        • Hand Surgery Quality Consortium
        Quality measures that address the upper limb.
        J Hand Surg Am. 2016; 41: 1041-1048.e22
        • Amanatullah D.F.
        • McQuillan T.
        • Kamal R.N.
        Quality measures in total hip and total knee arthroplasty.
        J Am Acad Orthop Surg. 2019; 27: 219-226
        • Eppler S.L.
        • Kakar S.
        • Sheikholeslami N.
        • Sun B.
        • Pennell H.
        • Kamal R.N.
        Defining quality in hand surgery from the patient’s perspective: a qualitative analysis.
        J Hand Surg Am. 2019; 44: 311-320.e4
        • Squitieri L.
        • Tsangaris E.
        • Klassen A.F.
        • et al.
        Patient-reported experience measures are essential to improving quality of care for chronic wounds: an international qualitative study.
        Int Wound J. 2020; 17: 1052-1061
        • Woolhead G.M.
        • Donovan J.L.
        • Dieppe P.A.
        Outcomes of total knee replacement: a qualitative study.
        Rheumatology (Oxford). 2005; 44: 1032-1037
        • Webster F.
        • Bremner S.
        • Katz J.
        • et al.
        Patients’ perceptions of joint replacement care in a changing healthcare system: a qualitative study.
        Healthc Policy. 2014; 9: 55-66
        • Sheetz K.H.
        • Waits S.A.
        • Girotti M.E.
        • Campbell Jr., D.A.
        • Englesbe M.J.
        Patients’ perspectives of care and surgical outcomes in Michigan: an analysis using the CAHPS hospital survey.
        Ann Surg. 2014; 260: 5-9
        • Goodman S.M.
        • Mehta B.
        • Mirza S.Z.
        • et al.
        Patients’ perspectives of outcomes after total knee and total hip arthroplasty: a nominal group study.
        BMC Rheumatol. 2020; 4: 3
        • Elliott D.
        • Study Group Bluebelle
        Developing outcome measures assessing wound management and patient experience: a mixed methods study.
        BMJ Open. 2017; 7e016155
        • Bunzli S.
        • O’Brien P.
        • Klem N.
        • et al.
        Misconceived expectations: patient reflections on the total knee replacement journey.
        Musculoskelet Care. 2020; 18: 415-424
        • McCaughan D.
        • Sheard L.
        • Cullum N.
        • Dumville J.
        • Chetter I.
        Patients’ perceptions and experiences of living with a surgical wound healing by secondary intention: a qualitative study.
        Int J Nurs Stud. 2018; 77: 29-38
        • Bates-Jensen B.M.
        Quality indicators for prevention and management of pressure ulcers in vulnerable elders.
        Ann Intern Med. 2001; 135: 744-751
        • Nazerali R.N.
        • Finnegan M.A.
        • Divi V.
        • Lee G.K.
        • Kamal R.N.
        Quality measures in breast reconstruction: a systematic review.
        Ann Plast Surg. 2017; 79: 320-325
        • Marks M.
        Which patient-reported outcomes shall we use in hand surgery?.
        J Hand Surg Eur Vol. 2020; 45: 5-11
        • Teunis T.
        • Thornton E.R.
        • Jayakumar P.
        • Ring D.
        Time seeing a hand surgeon is not associated with patient satisfaction.
        Clin Orthop Relat Res. 2015; 473: 2362-2368
        • Chung K.C.
        • Burns P.B.
        • Sears E.D.
        Outcomes research in hand surgery: where have we been and where should we go?.
        J Hand Surg Am. 2006; 31: 1373-1379
        • Graham B.
        Defining and measuring patient satisfaction.
        J Hand Surg Am. 2016; 41: 929-931
        • Birks M.E.
        • Sharma K.
        • Steele K.
        • Jones G.
        • Miller J.G.
        Understanding the patient profile and health-related quality of life in patients presenting for hand surgery.
        J Hand Surg Eur Vol. 2020; 45: 140-146
        • Poelstra R.
        • van Kooij Y.E.
        • van der Oest M.J.W.
        • et al.
        Patient’s satisfaction beyond hand function in Dupuytren’s disease: analysis of 1106 patients.
        J Hand Surg Eur Vol. 2020; 45: 280-285
        • Hageman M.G.J.S.
        • Briët J.P.
        • Bossen J.K.
        • Blok R.D.
        • Ring D.C.
        • Vranceanu A.M.
        Do previsit expectations correlate with satisfaction of new patients presenting for evaluation with an orthopaedic surgical practice?.
        Clin Orthop Relat Res. 2015; 473: 716-721
        • Kavalnienė R.
        • Deksnyte A.
        • Kasiulevičius V.
        • Šapoka V.
        • Aranauskas R.
        • Aranauskas L.
        Patient satisfaction with primary healthcare services: are there any links with patients’ symptoms of anxiety and depression?.
        BMC Fam Pract. 2018; 19: 90
        • Gualandi R.
        • Masella C.
        • Viglione D.
        • Tartaglini D.
        Exploring the hospital patient journey: what does the patient experience?.
        PLoS One. 2019; 14e0224899
        • Palinkas L.A.
        • Horwitz S.M.
        • Green C.A.
        • Wisdom J.P.
        • Duan N.
        • Hoagwood K.
        Purposeful sampling for qualitative data collection and analysis in mixed method implementation research.
        Adm Policy Ment Health. 2015; 42: 533-544
        • Glaser B.
        • Strauss A.
        The Discovery of Grounded Theory.
        Aldine Publishing, 1967
        • Chapman AL Hadfield M.
        • Chapman C.J.
        Qualitative research in healthcare: an introduction to grounded theory using thematic analysis.
        J R Coll Physicians Edinb. 2015; 45: 201-205
        • NVivo
        Learn More About Data Analysis Software.
        • Reilly C.A.
        • Doughty H.P.
        • Werth P.M.
        • Rockwell C.W.
        • Sparks M.B.
        • Jevsevar D.S.
        Creating a value dashboard for orthopaedic surgical procedures.
        J Bone Joint Surg Am. 2020; 102: 1849-1856
        • Mariano D.J.
        • Liu A.
        • Eppler S.L.
        • et al.
        Does a question prompt list improve perceived involvement in care in orthopaedic surgery compared with the AskShareKnow questions? A pragmatic randomized controlled trial.
        Clin Orthop Relat Res. 2021; 479: 225-232
        • Alderman A.K.
        • Chung K.C.
        Measuring outcomes in hand surgery.
        Clin Plast Surg. 2008; 35: 239-250
        • Kamal R.N.
        • Lindsay S.E.
        • Eppler S.L.
        Patients should define value in health care: a conceptual framework.
        J Hand Surg Am. 2018; 43: 1030-1034
        • Kane R.L.
        • Chung K.C.
        Establishing a national registry for hand surgery.
        J Hand Surg Am. 2020; 45: 57-61
        • Shapiro L.M.
        • Eppler S.L.
        • Roe A.K.
        • Morris A.
        • Kamal R.N.
        The patient perspective on patient-reported outcome measures following elective hand surgery: a convergent mixed-methods analysis.
        J Hand Surg Am. 2021; 46: 153.e1-153.e11