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Review
. 2021 Jun 28;6(6):439-450.
doi: 10.1302/2058-5241.6.210012. eCollection 2021 Jun.

Closing the loop: a 10-year experience with routine outcome measurements to improve treatment in hand surgery

Reinier Feitz  1   2 , Yara E van Kooij  1   3   4 , Marloes H P Ter Stege  1 , Mark J W van der Oest  1   3   4 , J Sebastiaan Souer  1 , Robbert M Wouters  1   3   4 , Harm P Slijper  1   3   4 , Ruud W Selles  3   4 , Steven E R Hovius  1   2 ; Hand–Wrist Study Group
Affiliations
Review

Closing the loop: a 10-year experience with routine outcome measurements to improve treatment in hand surgery

Reinier Feitz et al. EFORT Open Rev. .

Abstract

Routine outcome measurements as a critical prerequisite of value-based healthcare have received considerable attention recently. There has been less attention for the last step in value-based healthcare where measurement of outcomes also leads to improvement in the quality of care. This is probably not without reason, since the last part of the learning cycle: 'Closing the loop', seems the hardest to implement.The journey from measuring outcomes to changing daily care can be troublesome. As early adopters of value-based healthcare, we would like to share our 10 years of experience in this journey.Examples of feedback loops are shown based on outcome measurements implemented to improve our daily care process as a focused hand surgery and hand therapy clinic.Feedback loops can be used to improve shared decision making, to monitor or predict treatment progression over time, for extreme value detection, improve journal clubs, and surgeon evaluation.Our goal as surgeons to improve treatment should not stop at the act of implementing routine outcome measurements.We should implement routine analysis and routine feedback loops, because real-time performance feedback can accelerate our learning cycle. Cite this article: EFORT Open Rev 2021;6:439-450. DOI: 10.1302/2058-5241.6.210012.

Keywords: dashboard; patient-reported experience measurements; patient-reported outcome measurements; scorecard; surgeon feedback loop; value-based healthcare.

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Conflict of interest statement

ICMJE Conflict of interest statement: MJWVDO reports grants/grants pending from the FESSH/Foundation for Hand Surgery Clinical Research, outside the submitted work. RMW reports a grant to perform research from ZonMW, related to the submitted work. SERH reports he is a part-time practising hand surgeon and board member for Equipe Zorgbedrijven and payment for lectures including service on speakers bureaux from scientific institutions for lectures in general, all outside the submitted work. The other authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
Results of triangular fibrocartilage complex (TFCC) surgery of one specific surgeon. The graph depicts the outcome for open TFCC surgery from baseline to 12 months post surgery for pain during activity and function via the PRWE score. The green line is the median (p50) surgeon’s personal result (1st author) of his 94 cases versus the total of 848 patients in the database. The shaded areas illustrate the range of the 25th to 75th percentile for both the surgeon and the population. Also shown are the numbers of filled-in questionnaires as each time point used to calculate the graph. These outcome pictures are used in shared decision making to help the patient decide whether or not to opt for this procedure. Note. PRWE, Patient Rated Wrist/Hand Evaluation.
Fig. 2
Fig. 2
Plot of individual patients on PRWE results after open TFCC surgery. Chances of reaching a Minimal Clinical Important Difference (MCID) are minimal for a baseline PRWE lower than 34. Blue lines are patients who reached MCID, red lines for patients who failed to reach MCID (< 17). Note. PRWE, Patient Rated Wrist/Hand Evaluation; TFCC, triangular fibrocartilage complex.
Fig. 3
Fig. 3
Prediction model carpal tunnel release (CTR). Patients and caregivers fill in several items, for example, the Symptom Severity Scale of the BCTQ and the degree of pain. A chance is then displayed that the complaints will improve after CTR. This tool has been made publicly available online: https://analyse.equipezorgbedrijven.nl/shiny/cts-infographic/ Note. BCTQ, Boston Carpal Tunnel Questionnaire.
Fig. 4
Fig. 4
Results of patient 261654 routinely plotted against the overall outcome for TFCC injury. The red line shows the patient’s progress for the pain during activity and the PRWHE score. The shaded areas illustrate the range of the 25th to 75th percentile for the total population. These outcome pictures are used to evaluate the rehabilitation of each individual patient. Note. TFCC, triangular fibrocartilage complex; PRWHE, Patient Rated Wrist/Hand Evaluation.
Fig. 5
Fig. 5
Results of a journal club. Surgeons were interested in the outcomes of radial tunnel releases. This figure depicts the outcome of radial tunnel releases on the BCTQ over time. The researcher made a plot of 54 patients, for whom data were available, and presented this figure at a journal club meeting. Note. BCTQ, Boston Carpal Tunnel Questionnaire.
Fig. 6
Fig. 6
Screenshot of the Net Promotor Score (NPS) dashboard. The NPS is shown per year and overtime per half year. Also, the distribution of promoters, neutrals, and criticasters is shown.
Fig. 7
Fig. 7
Net Promotor Score (NPS) for each regional network in the Netherlands.
Fig. 8
Fig. 8
Patient-reported experience measurements (PREM); perception of the surgeon by the patient regarding knowledgeability, seriously listening, taking time, information about expected result, communication over the treatment, opportunity to raise questions, understandable explanation, shared decision making, waiting time before the consultation.
Fig. 9
Fig. 9
The handwheel, ICHOM standard set for hand and wrist conditions. Reproduced with permission of ICHOM (www.ichom.org). Note. ICHOM, International Consortium for Health Outcomes Measurement.
See this image and copyright information in PMC

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