Clinical quality measures for intraoperative and perioperative management in carpal tunnel surgery.
Clinical quality measures for intraoperative and perioperative management in carpal tunnel surgery.
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DOI：
10.1007/s11552-011-9325-9
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发表时间：
2011-06
期刊：
影响因子：
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通讯作者：
Asch, Steven M
中科院分区：
文献类型：
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作者：
Nuckols, Teryl K;Maggard Gibbons, Melinda;Harness, Neil G;Chang, Walter T;Chung, Kevin C;Asch, Steven M
以前的研究文献对接受手术的患者进行了次优的术前或术后护理。然而，很少有现有的质量措施直接解决手术护理的基本要素：术中护理过程。本研究旨在为腕管手术（美国常见手术）的术中、术前和术后护理制定质量措施。我们采用了一种广为接受的兰德/加州大学洛杉矶分校适当方法的变体。在几项研究中，坚持使用这种方法开发的措施与改善患者结局相关。手外科医生和质量测量专家使用指南和文献制定了测量草案。随后，在两轮改良德尔菲过程中，由11名腕管综合征国家专家（包括6名外科医生）组成的多学科小组审查了证据的结构化摘要，并对有效性（与改善患者结局的相关性）和可行性（使用医疗记录进行评估的能力）进行了评估。在25项措施草案中，小组成员认为22项（88%）是有效和可行的。9项术中测量涉及手术解剖的位置和范围、腕关节创伤后松解、内窥镜松解以及腕管手术期间有时进行的4项手术。11项措施包括术前和术后评估和管理。我们制定了几项措施，包括外科医生在内的专家认为这些措施可以反映腕管手术期间发生的护理过程的质量，并且可以使用医疗记录进行评估。虽然这些质量指标不能评估外科医生操作器械的技能，但它们可以评估术中护理的许多重要方面。应制定其他手术的术中措施。
Previous research documents suboptimal preoperative or postoperative care for patients undergoing surgery. However, few existing quality measures directly address the fundamental element of surgical care: intra-operative care processes. This study sought to develop quality measures for intraoperative, preoperative, and postoperative care for carpal tunnel surgery, a common operation in the USA. We applied a variation of the well-established RAND/UCLA Appropriateness Method. Adherence to measures developed using this method has been associated with improved patient outcomes in several studies. Hand surgeons and quality measurement experts developed draft measures using guidelines and literature. Subsequently, in a two-round modified-Delphi process, a multidisciplinary panel of 11 national experts in carpal tunnel syndrome (including six surgeons) reviewed structured summaries of the evidence and rated the measures for validity (association with improved patient outcomes) and feasibility (ability to be assessed using medical records). Of 25 draft measures, panelists judged 22 (88%) to be valid and feasible. Nine intraoperative measures addressed the location and extent of surgical dissection, release after wrist trauma, endoscopic release, and four procedures sometimes performed during carpal tunnel surgery. Eleven measures covered preoperative and postoperative evaluation and management. We have developed several measures that experts, including surgeons, believe to reflect the quality of care processes occurring during carpal tunnel surgery and be assessable using medical records. Although quality measures like these cannot assess a surgeon’s skill in handling the instruments, they can assess many important aspects of intraoperative care. Intraoperative measures should be developed for other procedures.