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Shapiro LM, Chang J, Fox PM, Kozin S, Chung KC, Dyer GS, Fufa D, Leversedge F, Katarincic J, Kamal R. The Development and Validation of Data Elements and Process Steps for an Electronic Health Record for Hand Surgery Outreach Trips. J Hand Microsurg 2023; 15:358-364. [PMID: 38152677 PMCID: PMC10751199 DOI: 10.1055/s-0042-1749465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background The surgical burden in low- and middle-income countries (LMICs) as reported by the number of surgical cases per capita is great. To improve global health and help address this burden, there has been a rise in surgical outreach to LMICs. In high-income countries, an electronic health record (EHR) is used to document and communicate data critical to the quality of care and patient safety. Despite this, there is little guidance or precedence on the data elements or processes for utilizing an EHR on outreach trips. We validated data elements and process steps for utilizing an EHR for hand surgery outreach trips. Methods We conducted a literature review to identify data elements collected during surgical outreach trips. A future-state process map for the collection and documentation of data elements within an EHR was developed through literature review and semistructured interviews with experts in global outreach. An expert consortium completed a modified RAND/University of California at Los Angeles Delphi process to evaluate the importance and feasibility of each data element and process step. Results In total, 65 data elements (e.g., date of birth) and 24 process steps (e.g., surgical site marking) were validated for use in an EHR for hand surgery outreach trips to LMICs. Conclusion This validated portfolio of data elements/process steps can serve as the foundation for pilot testing of an EHR to document and communicate critical patient data on hand surgery outreach trips. Utilization of an EHR during outreach trips to LMICs may serve to improve the safety and quality of care provided. The validated data elements/process steps can serve as a guide for EHR development and implementation of other surgical specialties.
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Affiliation(s)
- Lauren M. Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, United States
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California, United States
| | - Paige M. Fox
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California, United States
| | - Scott Kozin
- Department of Orthopaedic Surgery, Shriners Children's Philadelphia, Philadelphia, Pennsylvania, United States
| | - Kevin C. Chung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - George S.M. Dyer
- Department of Orthopaedics, Harvard Combined Orthopaedics Residency Program, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Duretti Fufa
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, United States
| | - Fraser Leversedge
- Department of Orthopaedic Surgery, University of Colorado Anschutz, Aurora, Colorado, United States
| | - Julie Katarincic
- Department of Orthopaedic Surgery, University Orthopedics, Rhode Island, United States
| | - Robin Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California, United States
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Welch JM, Kamal RN, Chatterjee M, Shapiro LM. Rates, Barriers, and Facilitators of Outcome Collection on Hand Surgery Outreach to Low- and Middle-Income Countries. Hand (N Y) 2023; 18:875-884. [PMID: 35048744 PMCID: PMC10336811 DOI: 10.1177/15589447211072200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Global outreach to low- and middle-income countries (LMICs) continues to grow in an effort to improve global health. The practice of quality measurement is empirically lacking from surgical outreach trips to LMICs, which may limit the safety and quality of care provided. Using convergent mixed-methods, we aimed to: (1) identify and evaluate barriers and facilitators to outcome measure collection; and (2) report the sample rate of such collection on hand surgery outreach trips to LMICs. METHODS Surgeons and administrators involved in hand surgery outreach trips completed a survey regarding rates of outcome measure collection and a semi-structured interview to explore barriers and facilitators of outcome collection. Survey data were reported descriptively. Interviews were recorded and transcribed, and excerpts were categorized according to the Pettigrew framework for strategic change (content, process, and context). Results were combined through convergent mixed-methods analysis. RESULTS Thirty-three participants completed the survey, and 21 participated in interviews. Rates of collection were the most common for total case number (83%) and patient mortality (65%). Longitudinal outcomes (eg, patient follow-up or time away from work) were less frequently recorded (9% and 4%, respectively). Content analysis revealed barriers related to each domain of the Pettigrew framework. CONCLUSIONS This analysis demonstrates low levels of outcome collection on outreach trips and identifies priority areas for improvement. Developing context-specific solutions aimed at addressing barriers (eg, resource/database availability) and promoting facilitators (eg, collaborative relationships) may encourage higher rates of collection, which stands to improve patient safety, quality of care, and accountability when conducting outreach trips to LMICs.
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Leversedge C, McCullough M, Appiani LMC, Đình MP, Kamal RN, Shapiro LM. Capacity Building During Short-Term Surgical Outreach Trips: A Review of What Guidelines Exist. World J Surg 2023; 47:50-60. [PMID: 36210361 PMCID: PMC9726663 DOI: 10.1007/s00268-022-06760-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION While short-term surgical outreach trips improve access to care in low- and middle-income countries (LMIC), there is rising concern about their long-term impact. In response, many organizations seek to incorporate capacity building programs into their outreach efforts to help strengthen local health systems. Although leading organizations, like the World Health Organization (WHO), advocate for this approach, uniform guidelines are absent. METHODS We performed a systematic review, using search terms pertaining to capacity building guidelines during short-term surgical outreach trips. We extracted information on authorship, guideline development methodology, and guidelines relating to capacity building. Guidelines were classified according to the Global-QUEST framework, which outlines seven domains of capacity building on surgical outreach trips. Guideline development methodology frequencies and domain classifications frequencies were calculated; subsequently, guidelines were aggregated to develop a core guideline for each domain. RESULTS A total of 35 studies were included. Over 200 individual guidelines were extracted, spanning all seven framework domains. Guidelines were most frequently classified into Coordination and Community Impact domains and least frequently into the Finance domain. Less than half (46%) of studies collaborated with local communities to design the guidelines. Instead, guidelines were predominantly developed through author trip experience. CONCLUSION As short-term surgical trips increase, further work is needed to standardize guidelines, create actionable steps, and promote collaborations in order to promote accountability during short-term surgical outreach trips.
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Affiliation(s)
- Chelsea Leversedge
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA USA
| | - Meghan McCullough
- Department of Plastic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA USA
| | - Luis Miguel Castro Appiani
- Department of Orthopaedic Surgery, Hospital Clinica Biblica, Aveinda 14 Calle 1 Y Central, San José, Costa Rica
| | - Mùng Phan Đình
- Orthropaedic Institute, 175 Military Hospital, Ho Chi Minh City, Vietnam
| | - Robin N. Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street MC: 6342, Redwood City, CA USA
| | - Lauren M. Shapiro
- Department of Orthopaedic Surgery, University of California, 1500 Owens St., San Francisco, CA USA
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Luan A, Mghase AE, Meyers N, Chang J. Are we curing by cutting? A call for long-term follow up and outcomes research in global surgery interventions - perspective. Int J Surg 2021; 87:105885. [PMID: 33513453 DOI: 10.1016/j.ijsu.2021.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/06/2023]
Abstract
Success in global surgery interventions cannot be claimed until consistent long-term follow up is achieved and corresponding outcomes are studied. However, post-operative outcomes remain inconsistently collected and analyzed in the setting of global surgery, with current efforts largely focused on the delivery of surgical care. Barriers in low- and middle-income countries include patient cost and distance, low surgical workforce capacity, poor patient health literacy, lack of affordable technology availability, inconsistent documentation, and structural deficiencies. Here, we suggest that future work can be focused on (1) enhancing systems to facilitate long-term follow up and care, (2) expanding availability and adoption of electronic medical record systems, and (3) collaboration with local surgeons in the development of international cross-organizational registries and standardized quality measures. Long-term collaborations between local healthcare administrators and providers, policymakers, international bodies, nonprofit organizations, patients, and the private sector are necessary to build and sustain processes to achieve reliable long-term follow up and rigorous data collection, with the goal of ultimately ensuring better patient outcomes.
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Affiliation(s)
- Anna Luan
- Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine, Stanford, CA, USA; ReSurge International, Sunnyvale, CA, USA.
| | - Adelaida E Mghase
- Department of Surgery, Plastic and Reconstructive Surgery Unit, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | | | - James Chang
- Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine, Stanford, CA, USA; ReSurge International, Sunnyvale, CA, USA
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Shapiro LM. Measuring and Improving the Quality of Care During Global Outreach Trips: A Primer for Safe and Sustainable Surgery. J Hand Surg Am 2020; 45:851-856.e2. [PMID: 32680787 DOI: 10.1016/j.jhsa.2020.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/13/2020] [Accepted: 04/29/2020] [Indexed: 02/02/2023]
Abstract
Trauma is the leading cause of mortality in patients aged 5 years and older. Globally, trauma kills more people than malaria, tuberculosis, and HIV/AIDs combined. As the number of surgical outreach trips to low- and middle-income countries and resources provided for such trips increase, hand surgeons are uniquely positioned to address this global burden. However, the delivery of surgical care alone is insufficient without effectively evaluating the quality of care delivered. It is critical that the care provided on outreach trips improves patient and population health, does not harm patients, and develops the local health care ecosystem. An estimated 8 million lives could be saved annually in low- and middle-income countries with higher-quality health systems. Currently, data collection systems for evaluating quality during outreach trips are lacking. Insight into current methods of quality assessment and improvement in both developing and developed countries can help inform future efforts to implement innovative data collection systems. Thoughtful and sustainable collaboration with host sites in low- and middle-income countries can ensure that care delivery is culturally competent and improves population health.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
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Discussion: Development and Validation of the Data Instrument for Surgical Global Outreach. Plast Reconstr Surg 2020; 145:865e-866e. [PMID: 32221242 DOI: 10.1097/prs.0000000000006701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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