title: Quality Measures in Upper Limb Surgery.
abstract: BACKGROUND
  Quality measures are now commonplace and are increasingly tied to financial incentives. We reviewed the existing quality measures that address the upper limb and tested the null hypothesis that structure (capacity to deliver care), process (appropriate care), and outcome (the result of care) measures are equally represented.
  
  
  METHODS
  We systematically reviewed MEDLINE/PubMed, Embase, Google Scholar, the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines, the National Quality Forum, the Agency for Healthcare Research and Quality, and the Physician Quality Reporting System for quality measures addressing upper limb surgery. Measures were characterized as structure, process, or outcome measures and were categorized according to their developer and their National Strategy for Quality Improvement in Health Care (National Quality Strategy) priority as articulated by the U.S. Department of Health & Human Services.
  
  
  RESULTS
  We identified 134 quality measures addressing the upper limb: 131 (98%) process and three (2%) outcome measures. The majority of the process measures address the National Quality Strategy priority of effective clinical care (90%), with the remainder addressing communication and care coordination (5%), person and caregiver-centered experience and outcomes (4%), and community/population health (1%).
  
  
  CONCLUSIONS
  Our review identified opportunities to develop more measures in the structure and outcome domains as well as measures addressing patient and family engagement, public health, safety, care coordination, and efficient use of resources. The most common existing measures-process measures addressing care-might not be the best measures of upper limb surgery quality given the relative lack of evidence for their use in care improvement.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, California rnkamal@stanford.edu.
authors.forename: Robin N
authors.initials: RN
authors.lastname: Kamal
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard University, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.affiliation: Department of Orthopaedic Surgery, Rhode Island Hospital/Brown University, Providence, Rhode Island.
authors.forename: Edward
authors.initials: E
authors.lastname: Akelman
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Yao
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: David S
authors.initials: DS
authors.lastname: Ruch
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Marc
authors.initials: M
authors.lastname: Richard
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
authors.forename: Amy
authors.initials: A
authors.lastname: Ladd
authors.affiliation: Department of Orthopaedic Surgery, Rhode Island Hospital/Brown University, Providence, Rhode Island.
authors.forename: Christopher
authors.initials: C
authors.lastname: Got
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard University, Boston, Massachusetts.
authors.forename: Philip
authors.initials: P
authors.lastname: Blazar
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kakar
mesh_terms: D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods*; D034941:Upper Extremity / Q000601:surgery*