TY - JOUR
T1 - Quality Measures to Reduce Opioid Use After Common Soft Tissue Hand and Wrist Procedures
AU - Hand Surgery Quality Consortium
AU - Zhuang, Thompson
AU - Shapiro, Lauren M.
AU - Ring, David
AU - Akelman, Edward
AU - Ruch, David S.
AU - Richard, Marc J.
AU - Ladd, Amy
AU - Blazar, Philip
AU - Yao, Jeffrey
AU - Kakar, Sanjeev
AU - Harris, Alex H.S.
AU - Got, Chris
AU - Kamal, Robin N.
N1 - Publisher Copyright:
© 2020 American Society for Surgery of the Hand
PY - 2020/7
Y1 - 2020/7
N2 - Purpose: To develop quality measures that are clinically important, feasible, usable, and scientifically acceptable for reducing opioid use after soft tissue procedures of the hand and wrist, and which can be used to evaluate quality in hand surgery. Methods: A consortium of 9 fellowship-trained hand/upper-limb surgeons with expertise in quality measure development used the RAND Corporation/University of California Los Angeles Delphi Appropriateness method to evaluate the validity of 2 quality measures for reducing opioid use, based on 4 quality indicators (clinical importance, feasibility, usability, and scientific acceptability). Panelists rated each measure on a scale of 1 (definitely not important/feasible/usable/supported) to 9 (definitely important/feasible/usable/supported) in 2 voting rounds with an intervening face-to-face discussion. Agreement was assessed using predetermined criteria. A measure was considered a valid quality measure if it received a median score of 7 or higher for all 4 indicators with no more than 2 panelists rating outside the range of 7 to 9. Results: Panelists achieved agreement on the 4 quality indicators for measuring the proportion of patients undergoing carpal tunnel release, trigger finger release, first dorsal compartment release, or ganglion cyst excision who received structured counseling on opioid use. Panelists also achieved agreement on the 4 quality indicators for measuring the proportion of patients without recent opioid use who did not fill an opioid prescription within 30 days after these procedures. Both candidate quality measures were considered valid. Conclusions: Using a validated consensus-building approach, we developed process and outcome quality measures for reducing opioid use after soft tissue hand surgery that were demonstrated to be valid according to 4 quality indicators. Clinical relevance: In the era of value-based health care, hand surgeons are assuming increasing responsibility in the prevention of excess opioid prescribing. Quality measures for reducing opioid overprescription can help promote the delivery of evidence-based, high-quality care in hand surgery.
AB - Purpose: To develop quality measures that are clinically important, feasible, usable, and scientifically acceptable for reducing opioid use after soft tissue procedures of the hand and wrist, and which can be used to evaluate quality in hand surgery. Methods: A consortium of 9 fellowship-trained hand/upper-limb surgeons with expertise in quality measure development used the RAND Corporation/University of California Los Angeles Delphi Appropriateness method to evaluate the validity of 2 quality measures for reducing opioid use, based on 4 quality indicators (clinical importance, feasibility, usability, and scientific acceptability). Panelists rated each measure on a scale of 1 (definitely not important/feasible/usable/supported) to 9 (definitely important/feasible/usable/supported) in 2 voting rounds with an intervening face-to-face discussion. Agreement was assessed using predetermined criteria. A measure was considered a valid quality measure if it received a median score of 7 or higher for all 4 indicators with no more than 2 panelists rating outside the range of 7 to 9. Results: Panelists achieved agreement on the 4 quality indicators for measuring the proportion of patients undergoing carpal tunnel release, trigger finger release, first dorsal compartment release, or ganglion cyst excision who received structured counseling on opioid use. Panelists also achieved agreement on the 4 quality indicators for measuring the proportion of patients without recent opioid use who did not fill an opioid prescription within 30 days after these procedures. Both candidate quality measures were considered valid. Conclusions: Using a validated consensus-building approach, we developed process and outcome quality measures for reducing opioid use after soft tissue hand surgery that were demonstrated to be valid according to 4 quality indicators. Clinical relevance: In the era of value-based health care, hand surgeons are assuming increasing responsibility in the prevention of excess opioid prescribing. Quality measures for reducing opioid overprescription can help promote the delivery of evidence-based, high-quality care in hand surgery.
KW - Hand surgery
KW - opioid use
KW - patient-centered care
KW - quality indicator
UR - http://www.scopus.com/inward/record.url?scp=85087530171&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087530171&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2020.03.007
DO - 10.1016/j.jhsa.2020.03.007
M3 - Article
C2 - 32408999
AN - SCOPUS:85087530171
SN - 0363-5023
VL - 45
SP - 582-588.e4
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 7
ER -