Evaluating the appropriateness of elective surgery: The case of spinal fusion (arthrodesis)
| Autor: | Guglielmo Pacileo, Valeria Domenica Tozzi, Lucia Ferrara |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Arthrodesis Measure (physics) ADMINISTRATIVE DATA Appropriateness of care ELECTIVE SURGERY 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Elective surgery Quality of care Retrospective Studies business.industry Health Policy Health Services MIXED METHODS QUALITY OF PATIENT CARE Italy SPINAL FUSION Elective Surgical Procedures Spinal fusion ADMINISTRATIVE DATA APPROPRIATENESS OF CARE ELECTIVE SURGERY MIXED METHODS QUALITY OF PATIENT CARE SPINAL FUSION Physical therapy business APPROPRIATENESS OF CARE 030217 neurology & neurosurgery |
| Zdroj: | Health Services Management Research. 34:167-177 |
| ISSN: | 1758-1044 0951-4848 |
| Popis: | Introduction Appropriateness is an essential element of quality of care. Several methods and tools have been developed to measure the appropriateness of care, however, none of these could be used to systematically support providers in keeping the appropriateness under control. Our study aimed to develop a framework to evaluate the appropriateness of care that took into account four dimensions of appropriateness: clinical dimension, equity, service delivery model, outcome. Methods We employed mixed-method approaches. These included a retrospective analysis of administrative data collected from Kinetika Sardinia (Italy) and a qualitative analysis of stakeholders’ experiences and perspectives aimed at supporting data collection, identification of improvement actions and definition of performance indicators. We used arthrodesis as a paradigmatic example of potentially inappropriate elective surgery. Results We collected data from 2,584 patients that underwent arthrodesis between January 1, 2010 and April 30, 2015. Based on the analysis and the exchanges with professionals, we identified 11 improvement actions. Monitoring and evaluation actions were finally conducted for 171 patients that underwent spinal fusion during the first semester of 2016 in order to assess if the improvement actions identified were put into practice and acquired desirable outcomes. Conclusions Our work provides a definition of appropriateness that goes beyond the clinical perspective and includes other perspectives (equity, service delivery and outcome); develops a framework and an approach that can be a valid help to systematically assess the appropriateness of elective surgery, adopt improvement actions, and monitor their impact; discusses what are the competencies necessary for measuring the appropriateness. |
| Databáze: | OpenAIRE |
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