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M I N A R S I N
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R G E R Y
28 (2015) 61–62
Available online at www.sciencedirect.com
www.elsevier.com/locate/semvascsurg
Quality of care measures for the vascular surgery patient Introduction
Structure
Providing high-quality care to patients with vascular disease is a goal for all vascular surgeons and affiliated health care providers. We know that high-quality care delivered to patients before, during, and after vascular surgery translates into better clinical outcomes, lower costs, and improved patient satisfaction [1]. But what is not always clear is how to define and measure the quality of care vascular surgery patients receive. Vascular providers need to know how to assess quality of care, understand which specific quality measures can be applied to vascular surgery, and learn how to identify new areas for quality improvement. Quality of care measures have traditionally been conceptualized within the framework of the Donebedian model [2]. This model, proposed back in 1966 by Avedis Donebedian, describes health care quality through the interconnected relationship between structure, process, and outcomes of the health care delivery system [3]. Structure describes the context in which care is delivered, process denotes the specific interventions delivered by providers to their patients during an episode of care, and outcomes reflect the impact of interventions on the health status of patients. But it is now recognized that other important measures of health care quality exist outside the Donebedian model [4]. This includes a patient’s experience (ie, patient-reported outcomes) of the care they receive within different health care settings, and their ability to obtain access to quality care in a timely and appropriate manner. All of these different types of measures are relevant to how we assess and improve the quality of care delivered to vascular surgery patients (Fig. 1). In this issue of Seminars in Vascular Surgery, we explore the current state of quality improvement in vascular surgery. We will provide a broad overview of quality measures that can be used to assess and improve the care of vascular surgery patients using examples of different types of quality measures across structural, process, outcomes, patient experience, and access categories (Fig. 1). This will include quality measures that have already been implemented in vascular surgery, as well as future initiatives for quality improvement.
Drs. Gonzales and Osborne will review hospital rating systems and how they are used to evaluate hospital quality.
Process Drs. Bartline and Brooke will present an implementation science framework for integration of evidence-based practices during the preoperative period for vascular surgery patients. Drs. Spangler and Goodney will provide an overview of smoking-cessation strategies and how these can be applied in clinical practice. Drs. Mendes and DeMartino provide an overview of optimal medication management in the perioperative period and the evidence underscoring the role of routine medical therapy to improve vascular surgery outcomes. Drs. Suckow and Stone will provide a review of existing quality measures for patients with critical limb ischemia, and propose new quality metrics for critical limb ischemia management.
Outcomes Drs. Beck and Bensley will discuss how the Vascular Quality Initiative can be used to track outcomes assessment of care quality that is delivered to vascular surgery patients in nationwide hospitals. Dr. Glebova and coauthors will review contemporary strategies to prevent unplanned readmissions in vascular surgery. Dr. van de Weijer and colleagues from the Netherlands provide a systematic review of variation in reported outcomes after femoro-popliteal artery bypass and the need for standardization of outcome assessment.
Patient experience Drs. Hicks and Lum will review different types of patientreported outcome measures available for patients with peripheral arterial disease.
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improvement in vascular surgery. We hope that practicing vascular surgeons can use this issue of Seminars to better understand the quality landscape as well as to identify measures that can be implemented and applied to their own clinical practice. Each article will touch on existing metrics, challenges, and opportunities for improving the care of vascular patients. Reviewing these studies might also stimulate ideas for future quality of care measures in vascular surgery.
re fe r en ces
Fig. 1 – Model for measuring quality of care in vascular surgery.
Access Drs. Hoel and Zamor from Northwestern will discuss transitions of care and follow-up surveillance after vascular surgery. Finally, Dr. Kraiss and colleagues discuss the assessment of frailty as a quality measure for screening patients and its impact on preoperative decision making and surgical outcomes. This collection of articles provides an overview of different types of quality measures as well as areas for future quality
[1] Cronenwett JL, Kraiss LW, Cambria RP. The Society for Vascular Surgery Vascular Quality Initiative. J Vasc Surg 2012;55:1529–37. [2] Larson JS, Muller A. Managing the quality of health care. J Health Hum Serv Adm 2002;25:261–80. [3] Donabedian A. Methods for deriving criteria for assessing the quality of medical care. Med Care Rev 1980;37:653–98. [4] Chow A, Mayer EK, Darzi AW, Athanasiou T. Patient-reported outcome measures: the importance of patient satisfaction in surgery. Surgery 2009;146:435–43.
Guest Editor Benjamin S. Brooke, MD, PhD Division of Vascular Surgery University of Utah School of Medicine IDEAS Center, VA SLC Health Care System Salt Lake City, UT http://dx.doi.org/10.1053/j.semvascsurg.2015.10.004 0895-7967/$ - see front matter & 2015 Elsevier Inc. All rights reserved.
M I N A R S I N
V
A S C U L A R
SU
R G E R Y
28 (2015) 61–62
Available online at www.sciencedirect.com
www.elsevier.com/locate/semvascsurg
Quality of care measures for the vascular surgery patient Introduction
Structure
Providing high-quality care to patients with vascular disease is a goal for all vascular surgeons and affiliated health care providers. We know that high-quality care delivered to patients before, during, and after vascular surgery translates into better clinical outcomes, lower costs, and improved patient satisfaction [1]. But what is not always clear is how to define and measure the quality of care vascular surgery patients receive. Vascular providers need to know how to assess quality of care, understand which specific quality measures can be applied to vascular surgery, and learn how to identify new areas for quality improvement. Quality of care measures have traditionally been conceptualized within the framework of the Donebedian model [2]. This model, proposed back in 1966 by Avedis Donebedian, describes health care quality through the interconnected relationship between structure, process, and outcomes of the health care delivery system [3]. Structure describes the context in which care is delivered, process denotes the specific interventions delivered by providers to their patients during an episode of care, and outcomes reflect the impact of interventions on the health status of patients. But it is now recognized that other important measures of health care quality exist outside the Donebedian model [4]. This includes a patient’s experience (ie, patient-reported outcomes) of the care they receive within different health care settings, and their ability to obtain access to quality care in a timely and appropriate manner. All of these different types of measures are relevant to how we assess and improve the quality of care delivered to vascular surgery patients (Fig. 1). In this issue of Seminars in Vascular Surgery, we explore the current state of quality improvement in vascular surgery. We will provide a broad overview of quality measures that can be used to assess and improve the care of vascular surgery patients using examples of different types of quality measures across structural, process, outcomes, patient experience, and access categories (Fig. 1). This will include quality measures that have already been implemented in vascular surgery, as well as future initiatives for quality improvement.
Drs. Gonzales and Osborne will review hospital rating systems and how they are used to evaluate hospital quality.
Process Drs. Bartline and Brooke will present an implementation science framework for integration of evidence-based practices during the preoperative period for vascular surgery patients. Drs. Spangler and Goodney will provide an overview of smoking-cessation strategies and how these can be applied in clinical practice. Drs. Mendes and DeMartino provide an overview of optimal medication management in the perioperative period and the evidence underscoring the role of routine medical therapy to improve vascular surgery outcomes. Drs. Suckow and Stone will provide a review of existing quality measures for patients with critical limb ischemia, and propose new quality metrics for critical limb ischemia management.
Outcomes Drs. Beck and Bensley will discuss how the Vascular Quality Initiative can be used to track outcomes assessment of care quality that is delivered to vascular surgery patients in nationwide hospitals. Dr. Glebova and coauthors will review contemporary strategies to prevent unplanned readmissions in vascular surgery. Dr. van de Weijer and colleagues from the Netherlands provide a systematic review of variation in reported outcomes after femoro-popliteal artery bypass and the need for standardization of outcome assessment.
Patient experience Drs. Hicks and Lum will review different types of patientreported outcome measures available for patients with peripheral arterial disease.
62
SE
M I N A R S I N
V
A S C U L A R
SU
R G E R Y
28 (2015) 61–62
improvement in vascular surgery. We hope that practicing vascular surgeons can use this issue of Seminars to better understand the quality landscape as well as to identify measures that can be implemented and applied to their own clinical practice. Each article will touch on existing metrics, challenges, and opportunities for improving the care of vascular patients. Reviewing these studies might also stimulate ideas for future quality of care measures in vascular surgery.
re fe r en ces
Fig. 1 – Model for measuring quality of care in vascular surgery.
Access Drs. Hoel and Zamor from Northwestern will discuss transitions of care and follow-up surveillance after vascular surgery. Finally, Dr. Kraiss and colleagues discuss the assessment of frailty as a quality measure for screening patients and its impact on preoperative decision making and surgical outcomes. This collection of articles provides an overview of different types of quality measures as well as areas for future quality
[1] Cronenwett JL, Kraiss LW, Cambria RP. The Society for Vascular Surgery Vascular Quality Initiative. J Vasc Surg 2012;55:1529–37. [2] Larson JS, Muller A. Managing the quality of health care. J Health Hum Serv Adm 2002;25:261–80. [3] Donabedian A. Methods for deriving criteria for assessing the quality of medical care. Med Care Rev 1980;37:653–98. [4] Chow A, Mayer EK, Darzi AW, Athanasiou T. Patient-reported outcome measures: the importance of patient satisfaction in surgery. Surgery 2009;146:435–43.
Guest Editor Benjamin S. Brooke, MD, PhD Division of Vascular Surgery University of Utah School of Medicine IDEAS Center, VA SLC Health Care System Salt Lake City, UT http://dx.doi.org/10.1053/j.semvascsurg.2015.10.004 0895-7967/$ - see front matter & 2015 Elsevier Inc. All rights reserved.
