Enhancing the quality of international orthopedic medical mission trips using the blue distinction criteria for knee and hip replacement centers

Abstract

BackgroundSeveral organizations seek to address the growing burden of arthritis in developing countries by providing total joint replacements (TJR) to patients with advanced arthritis who otherwise would not have access to these procedures. Because these mission trips operate in resource poor environments, some of the features typically associated with high quality care may be difficult to implement. In the U.S., many hospitals that perform TJRs use the Blue Cross/Shield’s Blue Distinction criteria as benchmarks of high quality care. Although these criteria were designed for use in the U.S., we applied them to Operation Walk (Op-Walk) Boston’s medical mission trip to the Dominican Republic. Evaluating the program using these criteria illustrated that the program provides high quality care and, more importantly, helped the program to find areas of improvement.MethodsWe used the Blue Distinction criteria to determine if Op-Walk Boston achieves Blue Distinction. Each criterion was grouped according to the four categories included in the Blue Distinction criteria— “general and administrative”, “structure”, “process”, or “outcomes and volume”. Full points were given for criteria that the program replicates entirely and zero points were given for criteria that are not replicated entirely. Of the non-replicated criteria, Op-Walk Boston’s clinical and administrative teams were asked if they compensate for failure to meet the criterion, and they were also asked to identify barriers that prevent them from meeting the criterion.ResultsOut of 100 possible points, the program received 71, exceeding the 60-point threshold needed to qualify as a Blue Distinction center. The program met five out of eight “required” criteria and 11 out of 19 “informational” criteria. It scored 14/27 in the “general” category, 30/36 in the “structure” category, 17/20 in the “process” category, and 10/17 in the “outcomes and volume” category.ConclusionOp-Walk Boston qualified for Blue Distinction. Our analysis highlights areas of programmatic improvement and identifies targets for future quality improvement initiatives. Additionally, we note that many criteria can only be met by hospitals operating in the U.S. Future work should therefore focus on creating criteria that are applicable to TJR mission trips in the context of developing countries.

Sustainability Assessment of a Short-Term International Medical Mission

“…One such catalyst for change was the Operation Walk Boston research program, which assesses the quality and outcomes of care provided by the mission 18,19 . The research was seen as a motivating force for change.…”

“…This program has partnered with a local hospital (Hospital General de la Plaza de la Salud [Hospital HGPS]) to provide pro-bono total joint arthroplasty to economically disadvantaged patients. We have documented positive patient outcomes 18 and high-quality care 19 in association with the Operation Walk Boston program. The specific goals of this investigation were to determine (1) what changes have occurred at Hospital HGPS as a result of the knowledge and skills imparted by Operation Walk Boston and (2) whether the volunteer experience influenced how the participants provide care in the U.S.…”

A Conceptual Model for the Evaluation of Surgical Missions

“…Using the Centers of Excellence criteria, a study found that Op-Walk Boston scored 71 points of a possible 100; a score of 60 qualifies as a Center of Excellence 21 . Op-Walk Boston was especially successful in satisfying process-based criteria, reflecting the capacity of the organization to collaborate with HGPS to implement high-quality processes of care, even in a resource-constrained environment.…”

Patient-Reported Outcomes After Total Hip Arthroplasty in a Low-Resource Country by a Visiting Surgical Team

“…Thus, despite the cost and complexity of these surgeries, hip and knee replacement are among medicine’s most cost-effective surgeries. Sadly, these surgeries are unavailable in many communities around the world [ 6 , 7 ]. For example, over the last 5 years in Pernambuco, Brazil, rates of hip and knee replacement declined at a time of increasing need, resulting in several thousands of patients wait-listed for surgery [ 8 ].…”