A Conceptual Model for the Evaluation of Surgical Missions

Abstract

Background:Medical missions to low and middle-income countries are increasingly frequent, with an estimated 6,000 trips sponsored by U.S. organizations accounting for approximately 200,000 surgical cases and $250 million in costs annually. However, these missions have received little critical evaluation. This paper describes the research program Operation Walk (Op-Walk) Boston, and proposes an evaluation model for similar surgical missions.Methods:We propose an evaluation model, borrowing from the work of Donabedian and enriched by evidence from our research program. The model calls for evaluation of the salient contextual factors (culture and beliefs), system management (structure, process, and outcomes), and sustainability of the program’s interventions. We used these domains to present findings from the quantitative and qualitative research work of Op-Walk Boston.Results:Op-Walk’s qualitative research findings demonstrated that cultural factors are important determinants of patients’ perceptions of arthritis etiology, physical activity patterns, and treatment preferences. Quantitative assessments documented that Dominican patients had worse lower-extremity functional status (mean Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function score of 33.6) and pain preoperatively than patients undergoing total hip or knee replacement in the U.S. (WOMAC function score of 43.3 to 54), yet they achieved excellent outcomes (50-point improvement), comparable to those of their U.S. counterparts. Assessments of the quality and sustainability of the Op-Walk program showed that the quality of care provided by Op-Walk Boston meets Blue Cross Blue Shield Centers of Excellence (Blue Distinction) criteria, and that sustainable changes were transferred to the host hospital.Conclusions:Our proposed model offers a method for formal assessment of medical missions that addresses the call for evidence of their merit. We suggest that surgical missions adopt quantitative and qualitative strategies to document their impact, identify areas of improvement, and justify program continuation, growth, and support.

Perceptions of Orthopaedic Volunteers and Their Local Hosts in Low- and Middle-Income Countries: Are We on the Same Page?

“…3 Overcoming cultural barriers may lead to improved patient education, which can contribute to the sustainability of the medical practice. 34…”

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

“…In addition, patients' own cultural beliefs, including their understanding of how their diseases manifest and preferring more natural treatments, contributes to the bias against surgery. Thus, assessment and incorporation of cultural factors into the care model, as proposed by Bido et al may enable improved care coordination and follow-up [30].…”

“…Thus, assessment and incorporation of cultural factors into the care model, as proposed by Bido et al. may enable improved care coordination and follow-up [ 30 ].…”

A comparative analysis of the health, financial, equity, and cost-effectiveness impacts of maxillofacial surgery in Guinea

“…8 In addition, NGO surgery can be costly; the costeffectiveness of such missions must be examined. 9,10 As a result, there have been calls for NGOs to take responsibility for measuring and reporting their outcomes and impact. 11 In this paper, we propose an evaluation of the impact of surgical care that goes beyond measuring volume.…”

“…8 In addition, NGO surgery can be costly; the cost-effectiveness of such missions must be examined. 9,10…”