Development of a Government Continuous Quality Improvement Procedure for Assessing the Provision of Bone Anchored Limb Prosthesis: A Process Re-Design Descriptive Study

Abstract

BACKGROUND: Evidences of sustainable clinical benefits of bone-anchored prosthesis (BAP) using osseointegrated fixation over typical socket-suspended prostheses are becoming more probing. This influx of individuals to be fitted with BAP has pressed government organisations to adjust their policies. However, the appraisal of consumer’s experience for the provision of BAP founded by government organisation is yet to be developed. This descriptive study shares the experience gained by a government organisation, namely the Queensland Artificial Limb Service (QALS), while developing a specific BAP-inclusive continuous quality improvement (CQI) procedure.
 OBJECTIVE(S): The primary objective was to present the methods and outcomes of key steps required to plan and create this CQI procedure. The secondary objective was to highlight key barriers and facilitators of the transition from a socket-focused to the proposed BAP-inclusive CQI procedure. 
 METHODOLOGY: The re-design process of the CQI procedure for 65 current QALS’s consumers with BAP involved a two-step process for the planning (e.g., case-mix, stakeholder) and creation (e.g., diagnosis, technical options, cost).
 FINDINGS: Prosthetists labour toward CQI procedure represented 1.3 hrs out of 22 hrs and AUD$213 out of AUD$3,300 or 6% of the whole procedure for the provision of BAP. The time spent by a prosthetist, consumer and QALS staff represented 24%, 24% and 53% of the time of the CQI procedure, respectively. The cost of prosthetist and QALS staff labour represented 70% and 30% of the CQI procedure, respectively.
 CONCLUSIONS: This descriptive study shares the workings and methodology that government organisations, such as QALS, can use to re-design a CQI procedure for comprehensive appraisal of the provision of prosthesis that could be inclusive of BAP and affordable while minimally time-consuming for prosthetists. The transition from a socket-focused to the proposed minimally disruptive BAP-inclusive CQI procedure was facilitated by prior knowledge of BAP treatment, early identification of the stakeholders and adaptation of current CQI procedure.
 Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/31326/24425
 LAYMAN’S ABSTRACT
 There is evidence supporting the long term clinical benefits of bone-anchored prosthesis (BAP) using an osseointegrated fixation over typical socket-suspended prostheses. The increasing number of individuals treated with osseointegrated fixation has pressed government organisations to adjust their policies for fair and equitable provision of prosthetic care. However, the appraisal of consumer’s experience for the provision of BAP by government organisation is yet to be developed. This descriptive study has fulfilled this need by sharing the experience gained by a QALS while developing a specific BAP-inclusive continuous quality improvement (CQI) procedure. This study revealed that government organisations can design a CQI procedure for comprehensive appraisal of the provision of prosthesis that could be inclusive of BAP and affordable while minimally time-consuming for prosthetists. The transition from a socket-focused to the proposed minimally disruptive BAP-inclusive CQI procedure was facilitated by prior knowledge of BAP treatment, early identification of the stakeholders and adaptation of current CQI procedure.
 How to Cite: Frossard L, Ferrada L, Quincey T, Burkett B, Berg D. Development of a government continuous quality improvement procedure for assessing the provision of bone anchored limb prosthesis: a process re-design descriptive study. Canadian Prosthetics & Orthotics Journal, Volume 1, Issue 2, No 4, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.31326

Survey data on the quality of life of consumers fitted with osseointegrated fixation and bone-anchored limb prostheses provided by government organization

“…This study involved all of 65 QALS′ consumers fitted with at least one bone-anchored prosthesis after implantation of press-fit (N = 64) or screw-type (N = 1) osseointegration fixation between 01/2011 and 06/2019. This cohort represented circa 16% and 7% of existing population estimated at 400 in Australia and 950 worldwide, respectively [1]. A total of 12 out of 65 consumers fitted with bone-anchored prosthesis between 07/2012 and 04/2019 responded to the survey, giving a return rate of 18%.…”

“…This specifically-designed survey data on the quality of life was administered by Queensland Artificial Limb Services (QALS), an Australian State government organization, as an integrated part of its continuous quality improvement procedure for assessing the provision of bone-anchored prosthesis [1], [8], [9], [10]. This survey was designed to assess change in quality of life experienced by QALS's consumers before and after implantation of a press-fit or screw-type osseointegrated fixation when fitted with conventional socket-suspended and bone-anchored limb prosthesis, respectively [3], [4], [11].…”

“…This benchmark information could be used in future comparative studies or meta-analyses involving other cohorts of individuals fitted with socket-suspended or bone-anchored prostheses, respectively [5], [6], [7].This new insight into the quality of life reported by consumers fitted with bone-anchored prosthesis provided by a governmental organization can contribute to inform the design of specific and more advanced quality of life surveys that could be administered by other government organizations supporting provision of bone-anchored prosthesis. This information will be particularly valuable to those who have limited opportunities to administer standard generic health-related quality of life surveys (e.g., SF-36) as part of their continuous quality improvement of procedure [1].This quality of life data can also be valuable for researchers designing observational studies and clinical trials looking at the overall effects of particular interventions (e.g., design of osseointegrated fixation, effects of bone-anchored prosthesis components) on patients' satisfaction and quality of life. For instance, the magnitude of the difference between quality of life experienced with socket-suspended and bone-anchored prosthesis can informed the sample size required to achieve sufficient statistical power during the analytical planning stage.…”

“…The survey data presented here provided an initial appraisal of the change in quality of life following surgical implantation of osseointegrated fixation, enabling direct skeletal attachment of the prosthesis, experienced by consumers supported by an Australian State government [1]. This specifically-designed survey focused on multiple facets of quality of life deriving essentially from safety and efficacy of the procedure as well as overall satisfaction with prosthesis [2], [3], [4].…”

“…This new insight into the quality of life reported by consumers fitted with bone-anchored prosthesis provided by a governmental organization can contribute to inform the design of specific and more advanced quality of life surveys that could be administered by other government organizations supporting provision of bone-anchored prosthesis. This information will be particularly valuable to those who have limited opportunities to administer standard generic health-related quality of life surveys (e.g., SF-36) as part of their continuous quality improvement of procedure [1].…”