Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review
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The ability to measure health system quality has become a priority for governments, the private sector, and the public. Quality indicators (QIs) refer to clear, measurable items related to outcomes. The use of QIs can initiate local quality improvement and track changes in quality over time as interventions are implemented.
We identified existing evidence-based indicators of quality pediatric orthopaedic care and evaluated published QIs that may be applicable to pediatric orthopaedic care.
Using five standard search engines we searched the literature using terms such as “quality indicators,” “orthopaedic surgery,” and “pediatric.” Study selection was performed in a stepwise manner, first by title, then abstract, and then full-text review. Of the 604 citations identified, 13 articles were selected for inclusion. Eight papers included only pediatric patients.
The most commonly reported indicator was mortality followed by postoperative complications. Reoperation and readmission rates were also reported along with patient-centered QIs, although with less frequency.
Although mortality and postoperative complications were the most frequently reported QIs, concern for their applicability was raised because of their relative infrequency in pediatrics. Patient-centered QIs appear to be the most useful tools reported, although their use is somewhat limited in the published literature. Although there are benefits and drawbacks to all reported QIs, patient-centered and surgeon-defined outcomes along with cost-effectiveness have important roles in evaluating the quality of pediatric orthopaedic care.
- AHRQ Quality Indicators. Pediatric Quality Indicators Overview. February 2006. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.qualityindicators.ahrq.gov/pdi_overview.htm. Accessed December 6, 2010.
- Beal AC, Co JT, Dougherty D, Jorsling T, Kam J, Perrin J, Palmer RH. Quality measures for children’s health care. Pediatrics. 2004;113;199–209.
- Bordley WC. Outcomes research and emergency medical services for children: domains, challenges, and opportunities. Ambul Pediatr. 2002;2:306–310. CrossRef
- Bradley EH, Holmboe ES, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM. A qualitative study of increasing beta-blocker use after myocardial infarction: why do some hospitals succeed? JAMA. 2001;285:2604–2611. CrossRef
- Brauer CA, Neumann PJ, Rosen AB. Trends in cost-effectiveness analyses in orthopedic surgery. Clin Orthop Relat Res. 2007;457:42–48.
- Brien SE, Lorenzetti DL, Lewis S, Kennedy J, Ghali WA. Overview of a formal scoping review on health system report cards. Implement Sci. 2010;5:1–12. CrossRef
- Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). Injury data were obtained from the database of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), Public Health Agency of Canada. Available at: www.phac-aspc.gc.ca/injury-bles/chirpp/index-eng.php. Accessed April 17, 2011.
- Canadian Pediatric Society. A model of paediatrics: rethinking health care for children and youth. Position Statement (CPS 2009–01). Paediatr Child Health. 2009;14:319–325.
- Chambers M, Clarke A. Measuring readmission rates. BMJ. 1990;301:1134–1136. CrossRef
- Cox PJ, Clarke NM. Improving the outcome of paediatric orthopaedic trauma: an audit of inpatient management in Southampton. Ann R Coll Surg Engl. 1997;79:441.
- Croft AM, Lynch P, Smellie JS, Dickinson CJ. Outpatient waiting times: indicators of hospital performance? J R Army Med Corps. 1998;144:131–137.
- Falagas ME, Pitsouni EI, Malietzis GA, Pappas G. Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. FASEB J. 2008;22:338–342. CrossRef
- Feldman DE, Bernatsky S, Houde M. The incidence of juvenile rheumatoid arthritis in Quebec: a population data-based study. Pediatr Rheumatol. 2009;7:20. CrossRef
- Gallagher C. Applying quality improvement tools to quality planning: pediatric femur fracture clinical path development. J Healthcare Q. 1994;16:6–14. CrossRef
- Guttman A, Razzaq A, Lindsay P, Zagorski B, Anderson GM. Development of measures of the quality of emergency department care for children using a structured panel process. Pediatrics. 2006;118:114–123. CrossRef
- Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–499. CrossRef
- Idvall E, Hamrin E, Sjöström B, Unosson M. Patient and nurse assessment of quality of care in postoperative pain management. Qual Saf Health Care. 2002;11:327–334. CrossRef
- Kirby MJL (Chair), LeBreton M. The Health of Canadians—The Federal Role (Final Report). The Standing Senate Committee on Social Affairs, Science, and Technology, October 2002. Available at: www.parl.gc.ca/37/2/parlbus/commbus/senate/com-e/soci-e/rep-e/repoct02vol6-e.htm. Accessed December 6, 2010.
- Kuhlthau K, Ferris TG, Iezzoni LI. Risk adjustment for pediatric quality indicators. Pediatrics. 2004;113;210–216. CrossRef
- Lacour-Gayet F, Clarke DR; the Aristotle Committee. The Aristotle method: a new concept to evaluate quality of care based on complexity. Curr Opin Pediatr. 2005;17:412–417. CrossRef
- Lanford A, Clausen R, Mulligan J, Hollenback C, Nelson S, Smith V. Measuring and improving patients’ and families’ perceptions of care in a system of pediatric hospitals. J Quality Improve. 2001;278:415–429.
- Mazankowski D (Chair). A Framework for Reform: Report of the Premier’s Advisory Council on Health. Alberta Health and Wellness, February 2002. Available at: www.premiersadvisory.com/reform.html. Accessed December 6, 2010.
- McDonald KM, Davies SM, Haberland CA, Gepper JJ, Ku A, Romano PS. Preliminary assessment of pediatric health care quality and patient safety in the United States using readily available administrative data. Pediatrics. 2008;122:e416. CrossRef
- Michelson J. Improved detection of orthopaedic surgical site infections occurring in outpatients. Clin Orthop Relat Res. 2005;433:218–224. CrossRef
- Moore JD Jr. Teaching hospitals have better outcomes. Modern Healthcare. 1999;29:34.
- Morrato EH, Dillon P, Ziegler M. Surgical outcomes research: a progression from performance audits, to administrative databases, to prospective risk-adjusted analysis—how far have we come? Curr Opin Pediatr. 2008;20:320–325. CrossRef
- Novak EJ, Vail TP, Bozic KJ. Advances in orthopaedic outcomes research. J Surg Orth Adv. 2008;17:200–203.
- Osler TM, Vane DW, Tepas JJ, Rogers FB, Shackford, S, Badger GJ. Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry. J Trauma. 2001;50:96–101. CrossRef
- Pike I, Piedt S, Warda L, Yanchar N, Macarthur C, Babul S, Macpherson AK. Developing injury indicators for Canadian children and youth: a modified-Delphi approach. Inj Prev. 2010;16:154. CrossRef
- Rogers SO. The holy grail of surgical quality improvement: process measures or risk-adjusted outcomes? Am Surg. 2006;72:1046–1050.
- Romanow R. Building on Values: The Future of Health Care in Canada (Final Report). Health Canada, November 2002. Available at: http://www.hc-sc.gc.ca/english/care/romanow/hcc0023.html. Accessed December 6, 2010.
- Scanlon MC, Harris JM, Levy F, Sedman A. Evaluation of the agency for healthcare research and quality pediatric quality indicators. Pediatrics. 2008;121:e1723. CrossRef
- Sedman A, Harris JM 2nd, Schulz K, Schwalenstocker E, Remus D, Scanlon M, Bahl V. Relevance of the Agency for Healthcare Research and Quality patient safety indicators for children’s hospitals. Pediatrics. 2005;115:135–145. CrossRef
- Shaller D. Implementing and using quality measures for children’s health care: perspectives on the state of the practice. Pediatrics. 2004;113:217–227. CrossRef
- Showstack J. Improving quality of care in orthopedic surgery. Arthritis Rheum. 2003;48:289–290. CrossRef
- Skaggs DL, Roy AK, Vitale MG, Pfiefer C, Baird G, Femino D, Kay RM. Quality of evaluation and management of children requiring timely orthopaedic surgery before admission to a tertiary pediatric facility. J Pediatr Orthop. 2002;22:265–267. CrossRef
- SMARTRISK. The Economic Burden of Injury in Canada. Toronto: SMARTRISK; 2009.
- Steering Committee on Quality Improvement and Management and Committee on Practice and Ambulatory Medicine Pediatrics. Principles for the development and use of quality measures. Pediatrics. 2008;121:411–418. CrossRef
- Tepas JJ. The National Pediatric Trauma Registry: a legacy of commitment to control of childhood injury. Semin Pediatr Surg. 2004;13:126–132. CrossRef
- Welke KF, Diggs BS, Karamlou T, Ungerleider RM. Measurement of quality in pediatric cardiac surgery: understanding the threats to validity. ASAIO J. 2008;54:447–450. CrossRef
- Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review
Clinical Orthopaedics and Related Research®
Volume 470, Issue 4 , pp 1124-1132
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- 1. Division of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- 2. Department of Surgery, University of Calgary, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada