Quality Measures That Address the Upper Limb

Robin N. Kamal, David Ring, Edward Akelman, David S. Ruch, Marc J. Richard, Amy Ladd, Chris Got, Phil Blazar, Jeff Yao, Sanjeev Kakar

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Purpose Physicians, health care systems, and payers use quality measures to judge performance and monitor the outcomes of interventions. Practicing upper-limb surgeons desire quality measures that are important to patients and feasible to use, and for which it is fair to hold them accountable. Methods Nine academic upper-limb surgeons completed a RAND/University of California–Los Angeles Delphi Appropriateness process to evaluate the importance, feasibility, and accountability of 134 quality measures identified from systematic review. Panelists rated measures on an ordinal scale between 1 (definitely not valid) and 9 (definitely valid) in 2 rounds (preliminary round and final round) with an intervening face-to-face discussion. Ratings from 1 to 3 were considered not valid, 4 to 6 were equivocal or uncertain, and 7 to 9 were valid. If no more than 2 of the 9 ratings were outside the 3-point range that included the median (1–3, 4–6, or 7–9), panelists were considered to be in agreement. If 3 or more ratings of a measure were within the 1 to 3 range whereas 3 or more ratings were in the 7 to 9 range, panelists were considered to be in disagreement. Results There was agreement that 58 of the measures are important (43%), 74 are feasible (55%), and surgeons can be held accountable for 39 (29%). All 3 thresholds were met for 33 measures (25%). A total of 36 reached agreement for being unimportant (48%) and 57 were not suited for surgeon accountability (43%). Conclusions A minority of upper-limb quality measures were rated as important for care, feasible to complete, and suitable for upper-limb surgeon accountability. Clinical relevance Before health systems and payers implement quality measures, we recommend ensuring their importance and feasibility to safeguard against measures that may not improve care and might misappropriate attention and resources.

Original languageEnglish (US)
Pages (from-to)1041-1048.e22
JournalJournal of Hand Surgery
Volume41
Issue number11
DOIs
StatePublished - Nov 1 2016

Keywords

  • Hand surgery
  • performance measure
  • quality
  • quality measure
  • value

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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