Kwaliteitsindicatoren voor de orthopedie. Ontwikkeling en toepassing van een set indicatoren

In the media and in scientific publications there is a growing interest in the quality of health care and possible differences in quality among hospitals and doctors. Quality of care is important for patients who receive care and for doctors who deliver care. Central in this discussion is the question how we should measure quality of care. Indicators may be helpful in measuring quality of care. In this study we developed a set of indicators for orthopedic care in the hospital. The Dutch Health Care Inspectorate requested the National Institute for Public Health and the Environment (RIVM) to develop this set of indicators to support their inspection activities. This study was carried out in close collaboration with the Dutch Society of Orthopaedic Care (NOV). To define a limited set of indicators for orthopedic care, three steps were taken. The first step was a search of peer-reviewed articles which descibe indicators related to the outcome of orthopedic care. The second step was a consensus procedure among specialists in the field of orthopedics to define a limited set of relevant indicators. This resulted in a set of 24 indicators. In the third step, these indicators were studied in a feasibility study during four months in three hospitals. We evaluated the use of the indicators by means of questionnaires and interviews with personal of the hospitals. Finally a set of 13 indicators was selected for further implementation. The set consists of indicators for the structure of care (time of surgery, availability of early discharge program, availability of ultra-clean air regulation), indicators for the process of care (participation of discharge paths, use of ultra clean air regulation, and preadmission patient education), and the outcome of care (deep vein thrombosis, pulmonary embolism, deep wound infection, urinary tract infection, dislocation, incidence of severe decubitus, and average length of stay). The evaluation study showed that registration of the indicators was not satisfactory feasible with the method used. Further development of a registration method and data-processing structure is necessary to make implementation of the indicators possible