Development of International Quality Measures Targeting Low-Value Care in Hand Surgery

Abstract

Purpose

Low-value care, defined as care in which there is no evidence of benefit, increases the risk of harm, or adds unnecessary costs, persists in hand and upper extremity care globally. To date, there are no quality measures to measure low-value care for a global setting. We aimed to develop international quality measures that are important, feasible, usable, and scientifically acceptable for reducing low-value care in hand surgery.

Methods

We performed a literature review to identify areas of potential low-value care for hand surgery. A consortium of 11 United States-based surgeons with experience in hand and upper-extremity surgery and/or quality measure development completed a modified Research and Development (RAND)/ University of California, Los Angeles (UCLA) Delphi Appropriateness process to evaluate the importance, feasibility, usability, and scientific acceptability of 10 candidate quality measures to reduce low-value hand surgical care. A modified RAND/UCLA Delphi Appropriateness process was subsequently conducted that included a panel of 20 international hand surgeons who voted on the same 10 measures using the same voting criteria. Panelist agreement or disagreement was assessed using predetermined criteria.

Results

United States and international panelists achieved agreement on the four criteria for five of the 10 measures; thus, these five measures were deemed valid. These measures include minimizing the unnecessary use of immobilization for fifth metacarpal neck fractures, postinjury imaging of distal radius fractures, perioperative antibiotics for soft tissue hand surgery, pre-operative testing, and opioid use after hand surgery. Two measures were deemed valid by the US panelists only, and two measures were deemed valid by the international panel only.

Conclusions

United States- and international-based hand and upper-extremity surgeons achieved consensus on an international quality measure portfolio to reduce low-value care in hand surgery, which may vary in practices settings globally.

Clinical relevance

These quality measures may be used to reduce low-value care in many types of health systems globally.