Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach

BMC Medical Research Methodology

M. Didem Ayturk¹  Catarina I. Kiefe¹  Amy P. Rushing²  Holly E. Baselice²  Adrian Diaz²  Wendelyn M. Oslock²  Anghela Z. Paredes²  Victor K. Heh²  Scott A. Strassels²  Kevin B. Ricci²  Heena P. Santry³  Vijaya T. Daniel⁴  Angela M. Ingraham⁵ 

[1] Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA, USA;Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, USA;Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH, USA;Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, USA;Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH, USA;Department of Surgery, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 614, 43210, Columbus, OH, USA;Department of Surgery, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA, USA;Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI, USA;

关键词: Emergency general surgery;    Quality of care/patient safety;    Patient Outcomes;    Health care organizations and systems;    Resource use / survey research and questionnaire design / administrative data uses;   

DOI  :  10.1186/s12874-020-01096-7

来源: Springer

【 摘 要 】

BackgroundAcute Care Surgery (ACS) was developed as a structured, team-based approach to providing round-the-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. Lacking any prior evidence on optimizing outcomes for EGS patients, current implementation of ACS models has been idiosyncratic. We sought to use a Donabedian approach to elucidate potential EGS structures and processes that might be associated with improved outcomes as an initial step in designing the optimal model of ACS care for EGS patients.MethodsWe developed and implemented a national survey of hospital-level EGS structures and processes by surveying surgeons or chief medical officers regarding hospital-level structures and processes that directly or indirectly impacted EGS care delivery in 2015. These responses were then anonymously linked to 2015 data from the American Hospital Association (AHA) annual survey, Medicare Provider Analysis and Review claims (MedPAR), 17 State Inpatient Databases (SIDs) using AHA unique identifiers (AHAID). This allowed us to combine hospital-level data, as reported in our survey or to the AHA, to patient-level data in an effort to further examine the role of EGS structures and processes on EGS outcomes. We describe the multi-step, iterative process utilizing the Donabedian framework for quality measurement that serves as a foundation for later work in this project.ResultsHospitals that responded to the survey were primarily non-governmental and located in urban settings. A plurality of respondent hospitals had fewer than 100 inpatient beds. A minority of the hospitals had medical school affiliations.DiscussionOur results will enable us to develop a measure of preparedness for delivering EGS care in the US, provide guidance for regionalized care models for EGS care, tiering of ACS programs based on the robustness of their EGS structures and processes and the quality of their outcomes, and formulate triage guidelines based on patient risk factors and severity of EGS disease.ConclusionsOur work provides a template for team science applicable to research efforts combining primary data collection (i.e., that derived from our survey) with existing national data sources (i.e., SIDs and MedPAR).

【 授权许可】

CC BY