Skip to main content
SpringerLink
Log in

Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review

  • Symposium: Value Based Healthcare
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The ability to measure health system quality has become a priority for governments, the private sector, and the public. Quality indicators (QIs) refer to clear, measurable items related to outcomes. The use of QIs can initiate local quality improvement and track changes in quality over time as interventions are implemented.

Questions/purposes

We identified existing evidence-based indicators of quality pediatric orthopaedic care and evaluated published QIs that may be applicable to pediatric orthopaedic care.

Search Strategy

Using five standard search engines we searched the literature using terms such as “quality indicators,” “orthopaedic surgery,” and “pediatric.” Study selection was performed in a stepwise manner, first by title, then abstract, and then full-text review. Of the 604 citations identified, 13 articles were selected for inclusion. Eight papers included only pediatric patients.

Results

The most commonly reported indicator was mortality followed by postoperative complications. Reoperation and readmission rates were also reported along with patient-centered QIs, although with less frequency.

Conclusion

Although mortality and postoperative complications were the most frequently reported QIs, concern for their applicability was raised because of their relative infrequency in pediatrics. Patient-centered QIs appear to be the most useful tools reported, although their use is somewhat limited in the published literature. Although there are benefits and drawbacks to all reported QIs, patient-centered and surgeon-defined outcomes along with cost-effectiveness have important roles in evaluating the quality of pediatric orthopaedic care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. AHRQ Quality Indicators. Pediatric Quality Indicators Overview. February 2006. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.qualityindicators.ahrq.gov/pdi_overview.htm. Accessed December 6, 2010.

  2. Beal AC, Co JT, Dougherty D, Jorsling T, Kam J, Perrin J, Palmer RH. Quality measures for children’s health care. Pediatrics. 2004;113;199–209.

    PubMed  Google Scholar 

  3. Bordley WC. Outcomes research and emergency medical services for children: domains, challenges, and opportunities. Ambul Pediatr. 2002;2:306–310.

    Article  PubMed  Google Scholar 

  4. Bradley EH, Holmboe ES, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM. A qualitative study of increasing beta-blocker use after myocardial infarction: why do some hospitals succeed? JAMA. 2001;285:2604–2611.

    Article  PubMed  CAS  Google Scholar 

  5. Brauer CA, Neumann PJ, Rosen AB. Trends in cost-effectiveness analyses in orthopedic surgery. Clin Orthop Relat Res. 2007;457:42–48.

    PubMed  Google Scholar 

  6. Brien SE, Lorenzetti DL, Lewis S, Kennedy J, Ghali WA. Overview of a formal scoping review on health system report cards. Implement Sci. 2010;5:1–12.

    Article  Google Scholar 

  7. Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). Injury data were obtained from the database of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), Public Health Agency of Canada. Available at: www.phac-aspc.gc.ca/injury-bles/chirpp/index-eng.php. Accessed April 17, 2011.

  8. Canadian Pediatric Society. A model of paediatrics: rethinking health care for children and youth. Position Statement (CPS 2009–01). Paediatr Child Health. 2009;14:319–325.

    Google Scholar 

  9. Chambers M, Clarke A. Measuring readmission rates. BMJ. 1990;301:1134–1136.

    Article  PubMed  CAS  Google Scholar 

  10. Cox PJ, Clarke NM. Improving the outcome of paediatric orthopaedic trauma: an audit of inpatient management in Southampton. Ann R Coll Surg Engl. 1997;79:441.

    PubMed  CAS  Google Scholar 

  11. Croft AM, Lynch P, Smellie JS, Dickinson CJ. Outpatient waiting times: indicators of hospital performance? J R Army Med Corps. 1998;144:131–137.

    PubMed  CAS  Google Scholar 

  12. Falagas ME, Pitsouni EI, Malietzis GA, Pappas G. Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. FASEB J. 2008;22:338–342.

    Article  PubMed  CAS  Google Scholar 

  13. Feldman DE, Bernatsky S, Houde M. The incidence of juvenile rheumatoid arthritis in Quebec: a population data-based study. Pediatr Rheumatol. 2009;7:20.

    Article  Google Scholar 

  14. Gallagher C. Applying quality improvement tools to quality planning: pediatric femur fracture clinical path development. J Healthcare Q. 1994;16:6–14.

    Article  CAS  Google Scholar 

  15. Guttman A, Razzaq A, Lindsay P, Zagorski B, Anderson GM. Development of measures of the quality of emergency department care for children using a structured panel process. Pediatrics. 2006;118:114–123.

    Article  Google Scholar 

  16. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–499.

    Article  PubMed  CAS  Google Scholar 

  17. Idvall E, Hamrin E, Sjöström B, Unosson M. Patient and nurse assessment of quality of care in postoperative pain management. Qual Saf Health Care. 2002;11:327–334.

    Article  PubMed  CAS  Google Scholar 

  18. Kirby MJL (Chair), LeBreton M. The Health of Canadians—The Federal Role (Final Report). The Standing Senate Committee on Social Affairs, Science, and Technology, October 2002. Available at: www.parl.gc.ca/37/2/parlbus/commbus/senate/com-e/soci-e/rep-e/repoct02vol6-e.htm. Accessed December 6, 2010.

  19. Kuhlthau K, Ferris TG, Iezzoni LI. Risk adjustment for pediatric quality indicators. Pediatrics. 2004;113;210–216.

    Article  PubMed  Google Scholar 

  20. Lacour-Gayet F, Clarke DR; the Aristotle Committee. The Aristotle method: a new concept to evaluate quality of care based on complexity. Curr Opin Pediatr. 2005;17:412–417.

    Article  PubMed  Google Scholar 

  21. Lanford A, Clausen R, Mulligan J, Hollenback C, Nelson S, Smith V. Measuring and improving patients’ and families’ perceptions of care in a system of pediatric hospitals. J Quality Improve. 2001;278:415–429.

    Google Scholar 

  22. Mazankowski D (Chair). A Framework for Reform: Report of the Premier’s Advisory Council on Health. Alberta Health and Wellness, February 2002. Available at: www.premiersadvisory.com/reform.html. Accessed December 6, 2010.

  23. McDonald KM, Davies SM, Haberland CA, Gepper JJ, Ku A, Romano PS. Preliminary assessment of pediatric health care quality and patient safety in the United States using readily available administrative data. Pediatrics. 2008;122:e416.

    Article  PubMed  Google Scholar 

  24. Michelson J. Improved detection of orthopaedic surgical site infections occurring in outpatients. Clin Orthop Relat Res. 2005;433:218–224.

    Article  PubMed  Google Scholar 

  25. Moore JD Jr. Teaching hospitals have better outcomes. Modern Healthcare. 1999;29:34.

    Google Scholar 

  26. Morrato EH, Dillon P, Ziegler M. Surgical outcomes research: a progression from performance audits, to administrative databases, to prospective risk-adjusted analysis—how far have we come? Curr Opin Pediatr. 2008;20:320–325.

    Article  PubMed  Google Scholar 

  27. Novak EJ, Vail TP, Bozic KJ. Advances in orthopaedic outcomes research. J Surg Orth Adv. 2008;17:200–203.

    Google Scholar 

  28. Osler TM, Vane DW, Tepas JJ, Rogers FB, Shackford, S, Badger GJ. Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry. J Trauma. 2001;50:96–101.

    Article  PubMed  CAS  Google Scholar 

  29. Pike I, Piedt S, Warda L, Yanchar N, Macarthur C, Babul S, Macpherson AK. Developing injury indicators for Canadian children and youth: a modified-Delphi approach. Inj Prev. 2010;16:154.

    Article  PubMed  Google Scholar 

  30. Rogers SO. The holy grail of surgical quality improvement: process measures or risk-adjusted outcomes? Am Surg. 2006;72:1046–1050.

    PubMed  Google Scholar 

  31. Romanow R. Building on Values: The Future of Health Care in Canada (Final Report). Health Canada, November 2002. Available at: http://www.hc-sc.gc.ca/english/care/romanow/hcc0023.html. Accessed December 6, 2010.

  32. Scanlon MC, Harris JM, Levy F, Sedman A. Evaluation of the agency for healthcare research and quality pediatric quality indicators. Pediatrics. 2008;121:e1723.

    Article  PubMed  Google Scholar 

  33. Sedman A, Harris JM 2nd, Schulz K, Schwalenstocker E, Remus D, Scanlon M, Bahl V. Relevance of the Agency for Healthcare Research and Quality patient safety indicators for children’s hospitals. Pediatrics. 2005;115:135–145.

    Article  PubMed  Google Scholar 

  34. Shaller D. Implementing and using quality measures for children’s health care: perspectives on the state of the practice. Pediatrics. 2004;113:217–227.

    Article  PubMed  Google Scholar 

  35. Showstack J. Improving quality of care in orthopedic surgery. Arthritis Rheum. 2003;48:289–290.

    Article  PubMed  Google Scholar 

  36. Skaggs DL, Roy AK, Vitale MG, Pfiefer C, Baird G, Femino D, Kay RM. Quality of evaluation and management of children requiring timely orthopaedic surgery before admission to a tertiary pediatric facility. J Pediatr Orthop. 2002;22:265–267.

    Article  PubMed  Google Scholar 

  37. SMARTRISK. The Economic Burden of Injury in Canada. Toronto: SMARTRISK; 2009.

  38. Steering Committee on Quality Improvement and Management and Committee on Practice and Ambulatory Medicine Pediatrics. Principles for the development and use of quality measures. Pediatrics. 2008;121:411–418.

    Article  Google Scholar 

  39. Tepas JJ. The National Pediatric Trauma Registry: a legacy of commitment to control of childhood injury. Semin Pediatr Surg. 2004;13:126–132.

    Article  PubMed  Google Scholar 

  40. Welke KF, Diggs BS, Karamlou T, Ungerleider RM. Measurement of quality in pediatric cardiac surgery: understanding the threats to validity. ASAIO J. 2008;54:447–450.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Calgary, AB, Canada

    Angeliki Kennedy MSc, Christina Bakir MD & Carmen A. Brauer MD, MSc (Health Econ), FRCSC

  2. Department of Surgery, University of Calgary, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada

    Carmen A. Brauer MD, MSc (Health Econ), FRCSC

Authors
  1. Angeliki Kennedy MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina Bakir MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carmen A. Brauer MD, MSc (Health Econ), FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carmen A. Brauer MD, MSc (Health Econ), FRCSC.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

The University of Calgary Department of Surgery Research Prize and the University of Calgary COREF Grant provided educational grants to complete this research.

About this article

Cite this article

Kennedy, A., Bakir, C. & Brauer, C.A. Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review. Clin Orthop Relat Res 470, 1124–1132 (2012). https://doi.org/10.1007/s11999-011-2060-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-2060-2

Keywords

Search

Navigation