Volunteers in Plastic Surgery Guidelines for Providing Surgical Care for Children in the Less Developed World

Schneider, W.; Politis, George D.; Gosain, Arun K.; Migliori, Mark R.; Cullington, James R.; Peterson, Elizabeth L.; Corlew, Scott; Wexler, Andrew; Flick, Randall P.; Beek, Allen L. Van

doi:10.1097/prs.0b013e3182131d2a

Cited by 72 publications

(62 citation statements)

References 7 publications

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“…Although there is a growing body of quality assessment literature for medical mission trips in other fields [12], our study is the first to evaluate programmatic quality in the context of an international TJR medical mission trip. Coupled with previously published outcomes data from the Op-Walk Boston program that showed patients’ pain and function greatly improved after their TJR surgeries [17], it seems that the Op-Walk Boston team provides high quality care to the patients it serves in the D.R.…”

Section: Discussionmentioning

confidence: 99%

“…Ideally, all medical mission trips would offer services with quality that is equal to the services offered in developed countries. Although some attempts have been made to standardize surgical procedures during medical mission trips [11,12], quality criteria have not been established for TJR medical mission trips. One set of guidelines commonly used as a benchmark of TJR quality in the U.S. is the Blue Cross/Shield’s “Blue Distinction Center for Knee and Hip Replacement” criteria, which provide quality benchmarks for a range of program features including structural elements, processes, provider certifications, and reporting.…”

Section: Introductionmentioning

confidence: 99%

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

Dempsey

Ghazinouri

Diez

et al. 2013

BMC Musculoskelet Disord

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Dempsey

Ghazinouri

Diez

et al. 2013

BMC Musculoskelet Disord

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“…The traditional “missions” model of cleft care rests partially on the premise that one-time interventions can effectively treat craniofacial anomalies, that they produce a high return for time and resources invested, and that they are feasible commitments for visiting providers [18, 42–44]. However, as cleft palate missions have grown in scale and scope, they have demonstrated a willingness to think critically about their care delivery models.…”

Section: Building Capacity While Addressing Specific Needs: a Diagmentioning

confidence: 99%

An Opportunity for Diagonal Development in Global Surgery: Cleft Lip and Palate Care in Resource-Limited Settings

Patel

Hoyler

Maine

et al. 2012

Plastic Surgery International

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Global cleft surgery missions have provided much-needed care to millions of poor patients worldwide. Still, surgical capacity in low- and middle-income countries is generally inadequate. Through surgical missions, global cleft care has largely ascribed to a vertical model of healthcare delivery, which is disease specific, and tends to deliver services parallel to, but not necessarily within, the local healthcare system. The vertical model has been used to address infectious diseases as well as humanitarian emergencies. By contrast, a horizontal model for healthcare delivery tends to focus on long-term investments in public health infrastructure and human capital and has less often been implemented by humanitarian groups for a variety of reasons. As surgical care is an integral component of basic healthcare, the plastic surgery community must challenge itself to address the burden of specific disease entities, such as cleft lip and palate, in a way that sustainably expands and enriches global surgical care as a whole. In this paper, we describe a diagonal care delivery model, whereby cleft missions can enrich surgical capacity through integration into sustainable, local care delivery systems. Furthermore, we examine the applications of diagonal development to cleft care specifically and global surgical care more broadly.

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“…10 For this reason, many cleft organizations who conduct medical missions in the underdeveloped and developing countries have a strict protocol of advising obturator device to the adult patients with cleft palate rather than surgically correcting the deformity. 11 Because of the radical release of the pedicle as recommended in our technique, wide clefts even in adult patients can be easily repaired without any tension.…”

Section: Discussionmentioning

confidence: 98%

Radical Dissection of Greater Palatine Artery and Dynamic Reconstruction of Cleft Palate

Fayyaz

Gill

Chaudry

et al. 2017

Plastic and Reconstructive Surgery - Global Open

114

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Background:Restoration of proper anatomy and physiology is an integral part of cleft palate repair. The senior author has devised a new technique of radical release of greater palatine vessels, which helps in achieving tension-free closure of palatal cleft. In addition, release and transposition of palatal muscles is performed without the use of operative microscope, resulting in improved palatal function. This technique is applicable to all types of clefts of the palate and can be performed on adult patients as well.Materials and Methods:This is a retrospective case series of cleft palate repairs performed over a period of 3 years. Single-stage repair with modified Bardach’s technique for complete cleft palate and von Langenbeck’s technique for incomplete cleft palate with radical release of greater palatine vessels and levator complex retropositioning was performed. The outcome measures were closure of palatal defect and speech production. A follow-up of at least 6 months was completed in each patient.Results:A total of 1568 patients were included in the study. Their age ranged from 9 months to 54 years. The overall fistula rate was 6.1%. Improvement of speech was observed even in adult patients.Conclusions:Radical release of greater palatine artery and levator complex transposition can dramatically improve results of cleft palate repair. This technique helps in dynamic reconstruction of cleft palate and can be effectively applied in all age groups.

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Volunteers in Plastic Surgery Guidelines for Providing Surgical Care for Children in the Less Developed World

Abstract: Any plastic surgery group undertaking an international mission trip should be able to go to one source to find a detailed discussion of the perceived needs in providing high-quality, safe care for children. The present document was created to satisfy this need.

Cited by 72 publications

References 7 publications

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

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

An Opportunity for Diagonal Development in Global Surgery: Cleft Lip and Palate Care in Resource-Limited Settings

Radical Dissection of Greater Palatine Artery and Dynamic Reconstruction of Cleft Palate

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