Patient Follow‐up After Orthopaedic Outreach Trips – Do We Know Whether Patients are Improving?

Leversedge, Chelsea; Castro, Samuel Rodrigues; Appiani, Luis Miguel Castro; Kamal, Robin N.; Shapiro, Lauren M.

doi:10.1007/s00268-022-06630-w

Cited by 10 publications

(16 citation statements)

References 86 publications

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“…Beyond organizational and procedural factors, our study investigated the individual patient factors influencing followups. Previous literature has reported lack of technology and financial costs as major restrictions to patients' ability to be contacted and followed, 8,9 yet to the best of our knowledge, no report has statistically analyzed the correlation between specific SES factors and lack of follow-up. Our study found the majority of SES surrogate factors did not significantly correlate with follow-up attendance, with the exception of phone access.…”

Section: Discussionmentioning

confidence: 97%

“…6 Commonly noted barriers to follow-up care include weak or overwhelmed local infrastructure and logistical issues at the mission sites, including language constraints. 7,8 Sykes reported that some medical service organizations may not prioritize standardized evaluation tools, data collection, and analysis because research is thought to provide only limited mission benefits. 6 Other NGO's presume lack of technology, financial costs, misunderstandings about the need for further care, or remote location of a patient's home as barriers for patients' follow-up care and data collection.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Lack of Long-Term Follow-Up Data After Global Cardiac Surgery Missions

Lannon,

Nuchovich,

Louis

et al. 2024

World J Pediatr Congenit Heart Surg

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Background: Humanitarian medical missions attempt to lessen the burden of limited access to cardiac surgery in low- and middle-income countries. While organizations express difficulties obtaining follow-up information, there is currently little evidence to support the various assumptions for lack of data. This study examines the factors influencing long-term patient follow-ups on repeated short-term cardiac surgery missions across nine countries. Methods: A retrospective analysis of CardioStart International's database (RedCap) was conducted to investigate demographic, socioeconomic, and surgical factors associated with follow-ups. Results: A total of 550 pediatric (50%) and adult (50%) cardiac surgery patients displayed a follow-up rate of 14.7%, with no significant difference between populations ( P = 1). Mean follow-up time was 1.5 years postoperative. Countries were highly variable, with Dominican Republic and Vietnam showing follow-up rates of 30.4% and 43.2%, respectively, while Brazil, Nepal, and Tanzania had no follow-ups ( P < 0.0001). The 11 surrogate factors for socioeconomic status, including home amenities and technology access, were predominantly insignificant, with the exception of phone access showing an unexpectedly decreased follow-up rate (11.6%, P = 0.006). Surgical intervention was a significant factor ( P = 0.009). No adult cardiac surgery trends were noted; however, congenital cases demonstrated increased follow-ups in patients with higher Risk Adjusted Congenital Heart Surgery scores, with ventricular septal defects (32.5%) exceeding atrial septal defects (7.3%). Conclusions: Follow-ups correlate with mission factors, including location and types of intervention, more so than previously assumed socioeconomic and technological factors. Thus, certain missions may require more allocation of resources and adapted organizational policies to overcome site-specific barriers to follow-up.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Factors Associated With Lack of Long-Term Follow-Up Data After Global Cardiac Surgery Missions

Lannon,

Nuchovich,

Louis

et al. 2024

World J Pediatr Congenit Heart Surg

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“…Over 500 outreach organizations exist in the USA and an estimated 6000 trips are conducted annually [7,8], typically aiming to increase access to much needed surgical services. However, the lasting impact of such trips has been criticized due to their short-term nature, perpetuation of voluntourism and colonialist practices, limited preparation and training in local care and customs, sparse outcome collection, and lack of regulation [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Capacity Building During Short‐Term Surgical Outreach Trips: A Review of What Guidelines Exist

et al. 2022

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Introduction While short-term surgical outreach trips improve access to care in low- and middle-income countries (LMIC), there is rising concern about their long-term impact. In response, many organizations seek to incorporate capacity building programs into their outreach efforts to help strengthen local health systems. Although leading organizations, like the World Health Organization (WHO), advocate for this approach, uniform guidelines are absent. Methods We performed a systematic review, using search terms pertaining to capacity building guidelines during short-term surgical outreach trips. We extracted information on authorship, guideline development methodology, and guidelines relating to capacity building. Guidelines were classified according to the Global-QUEST framework, which outlines seven domains of capacity building on surgical outreach trips. Guideline development methodology frequencies and domain classifications frequencies were calculated; subsequently, guidelines were aggregated to develop a core guideline for each domain. Results A total of 35 studies were included. Over 200 individual guidelines were extracted, spanning all seven framework domains. Guidelines were most frequently classified into Coordination and Community Impact domains and least frequently into the Finance domain. Less than half (46%) of studies collaborated with local communities to design the guidelines. Instead, guidelines were predominantly developed through author trip experience. Conclusion As short-term surgical trips increase, further work is needed to standardize guidelines, create actionable steps, and promote collaborations in order to promote accountability during short-term surgical outreach trips.

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“…The impact of such partnerships, however, is not always known. For example, 2 recent systematic reviews have questioned the long-term impact of short-term outreach trips in orthopaedic surgery and plastic and reconstructive surgery, with both studies citing concerns related to low levels of follow-up, accountability, and complication rates 6,7 .…”

mentioning

confidence: 99%

Capacity Assessment Tool to Promote Capacity Building in Global Orthopaedic Surgical Outreach

Shapiro

Welch

Leversedge

et al. 2023

Journal of Bone and Joint Surgery

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Background: A growing number of nongovernmental organizations from high-income countries aim to provide surgical outreach for patients in low- and middle-income countries in a manner that builds capacity. There remains, however, a paucity of measurable steps to benchmark and evaluate capacity-building efforts. Based on a framework for capacity building, the present study aimed to develop a Capacity Assessment Tool for orthopaedic surgery (CAT-os) that could be utilized to evaluate and promote capacity building. Methods: To develop the CAT-os tool, we utilized methodological triangulation—an approach that incorporates multiple different types of data. We utilized (1) the results of a systematic review of capacity-building best practices in surgical outreach, (2) the HEALTHQUAL National Organizational Assessment Tool, and (3) 20 semistructured interviews to develop a draft of the CAT-os. We subsequently iteratively used a modified nominal group technique with a consortium of 8 globally experienced surgeons to build consensus, which was followed by validation through member-checking. Results: The CAT-os was developed and validated as a formal instrument with actionable steps in each of 7 domains of capacity building. Each domain includes items that are scaled for scoring. For example, in the domain of partnership, items range from no formalized plans for sustainable, bidirectional relationships (no capacity) to local surgeons and other health-care workers independently participating in annual meetings of surgical professional societies and independently creating partnership with third party organizations (optimal capacity). Conclusions: The CAT-os details steps to assess capacity of a local facility, guide capacity-improvement efforts during surgical outreach, and measure the impact of capacity-building efforts. Capacity building is a frequently cited and commendable approach to surgical outreach, and this tool provides objective measurement to aid in improving the capacity in low and middle-income countries through surgical outreach.

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Patient Follow‐up After Orthopaedic Outreach Trips – Do We Know Whether Patients are Improving?

Cited by 10 publications

References 86 publications

Factors Associated With Lack of Long-Term Follow-Up Data After Global Cardiac Surgery Missions

Factors Associated With Lack of Long-Term Follow-Up Data After Global Cardiac Surgery Missions

Capacity Building During Short‐Term Surgical Outreach Trips: A Review of What Guidelines Exist

Capacity Assessment Tool to Promote Capacity Building in Global Orthopaedic Surgical Outreach

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