title: Assessing the quality of surgical care in vascular surgery; moving from outcome towards structural and process measures.
abstract: OBJECTIVE
  This study presents a review of studies reporting on quality of care in vascular surgery. The aim of this study was to provide insight in quality improvement initiatives in vascular surgery.
  
  
  METHODS
  Original data were collected from MEDLINE and EMBASE databases. Inclusion criteria were: description of one of the three factors of quality of care, e.g. process, outcome or structure and prospectively described. All articles identified were ascribed to a domain of quality of care.
  
  
  RESULTS
  57 prospective articles were included, drawn from 859 eligible reports. Structure as an indicator of quality of care was described in 19 reports, process in 7 reports and outcome in 31 reports. Most studies based on structural measures considered the introduction of a clinical pathway or a registration system. Reports based on process measures showed promising results. Outcome as clinical indicator mainly focussed on identifying risk factors for morbidity, mortality or failure of treatment.
  
  
  CONCLUSIONS
  Structure and process indicators are evaluated scarcely in vascular surgery. Many studies in vascular surgery have been focussed on outcomes as indicator of quality of care, but a shift towards process measures should be considered as focus of attention in the future.
authors.affiliation: Leiden University Medical Center (LUMC), Department of Vascular Surgery, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands. a.j.ploeg@lumc.nl
authors.forename: A J
authors.initials: AJ
authors.lastname: Ploeg
authors.forename: H C
authors.initials: HC
authors.lastname: Flu
authors.forename: J H P
authors.initials: JH
authors.lastname: Lardenoye
authors.forename: J F
authors.initials: JF
authors.lastname: Hamming
authors.forename: P J
authors.initials: PJ
authors.lastname: Breslau
mesh_terms: D019091:Critical Pathways / Q000592:standards; D006302:Health Services Research / Q000592:standards*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards*