Thematic analysis of patient derived quality measures following upper limb surgery

OBJECTIVE: This study investigated how upper limb post-operative patients defined quality care. We specifically assessed the following three aims: (1) determining patient expectations following upper limb surgery, (2) identifying patient recognized barriers to receiving quality care, and (3) analyzing patient identified areas of improvement in patient education. METHOD: In total, 52 patients, aged 19 – 89 years (mean age: 48 years) who received upper limb surgery were surveyed with an open-ended questionnaire during their six to eight week post-operative visit at Stanford Medicine Outpatient Center in Redwood City or Stanford Orthopaedic Surgery Clinic in Los Gatos. Responses were electronically transcribed to REDcap, Research Electronic Data Capture System, for analysis of responses to demographic questions. Open-ended questions were evaluated by thematic analysis until data saturation was reached. RESULTS: Thematic analysis of open-ended responses revealed three main themes: (1) Pain, (2) Function; and (3) Patient Unpreparedness. Both pain and function involved pre- and post-operative factors. Of our three identified themes, elimination of pain and regaining function were the two main health-outcomes that upper limb patients identified as successful treatments of their condition. Patient unpreparedness was recognized as a main barrier in patients receiving quality care and an important area to improve patient education about their problem and treatment. CONCLUSION: By understanding the desired health outcomes and limitations in achieving those outcomes for post-operative upper limb patients, we can improve how medical care is practiced. Our results highlighted that both process and outcome domains of care are important elements in patients’ definition of quality care when seeking medical treatment for their upper limb problems. Specifically, patients identified that elimination of pain and regaining function were important health outcomes during their care. In order to achieve those desired health-outcomes, we recognized that improvements need to be made with regard to patient education about their health condition and treatment process, in order to foster better physician-patient communication. Overall, our findings support the need for continued focus on patient-centered care to ensure the delivery of quality healthcare to all patients