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

Abstract

Background Acute 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. Methods We 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. Results Hospitals 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. Discussion Our 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. Conclusions Our 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).

In-house intensivist presence does not affect mortality in select emergency general surgery patients

“…In 2015, we surveyed 2,811 US hospitals on the structures and processes being used to provide EGS care with a specific focus on critical care resources and infrastructure. 8 A copy of the survey is included in Supplemental Digital Content (Appendix 1, http://links.lww.com/TA/C59). A total of 1,690 hospitals (60.1%) responded nationwide.…”

Impact of the bidirectional relationship between communication and cognitive efficacy on orthopedic patient adherence behavior

“…Regarding the quality of healthcare services, the structure-process-outcome (SPO) model advocated by Donabedian [ 9 , 10 ] has played a significant role in quality assurance and improvements in the healthcare field. This model has been used to evaluate the overall quality of healthcare in several areas, such as emergency general surgery [ 11 ], integrated chronic disease management [ 12 ], antenatal care services [ 13 ], lung cancer [ 14 ], and prostate cancer [ 15 ]. Although the Donabedian SPO model is the leading paradigm for evaluating the quality of healthcare services, it does not sufficiently recognize the complex and hidden interrelationships among healthcare service processes [ 16 ].…”

“…Furthermore, Dibbelt et al [ 39 ] state that recovery success of the intrapsychic and physical function was attributed to the healthcare process, including factors such as information exchange, expectation adjustment, and decision adherence behavior. Effective physician-patient communication is a basic part of the treatment process [ 5 ], which relieves the patient’s psychological burden and leads to better healthcare outcomes [ 11 , 28 , 32 , 40 ]. Physicians and patients provide emotional support and exchange medical knowledge through communication [ 9 , 41 , 42 ].…”

Assessment of Staffing and Service Provision in the Post-Anesthesia Care Unit of Hospitals Found in Amhara Regional State, 2020

“…Postoperative care in early recovery should involve airway management and oxygen therapy, vital signs monitoring, postoperative pain management, postoperative nausea and vomiting treatment, treating post-anesthesia shivering, and monitoring surgical sites for complications such as bleeding, discharge, swelling, hematoma, wound healing, and infection. 1–3 …”