Value-Based Health Care in Hand Surgery: Where Are We &amp; Where Do We Go From Here?

Bernstein, David N.; Calfee, Ryan P.; Hammert, Warren C.; Rozental, Tamara D.; Witkowski, Mary; Porter, Michael E.

doi:10.1016/j.jhsa.2022.06.019

Cited by 6 publications

(2 citation statements)

References 17 publications

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“…The present study uses the recognized EuroQol EQ5D-5L questionnaire, which has previously been used to assess quality of life in individuals with lower-limb amputation from the Swedish Amputation and Prosthetics Registry (SwedeAmp) 19 but extends this by evaluating the difference preintervention and postintervention. Patient-reported outcome measures (PROMs) are vital in ensuring the delivery of value-based care 20 and particularly important within hand surgery where functionality is a key priority for patients. PROMs permit the evaluation of quality of care in terms of benefit to patients, and more work needs to be done to incorporate the measurement of these PROMs within surgical pathways from preoperative assessment through to postoperative follow-up.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Pain and Quality of Life in Patients Undergoing Targeted Muscle Reinnervation After Upper-Limb Amputations

Zargaran,

Nagra

et al. 2024

J Prosthet Orthot

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Introduction Targeted muscle reinnervation (TMR) surgery is now increasingly performed when individuals with amputation develop problems with chronic, nerve-related limb pain. This study evaluates the effectiveness of TMR for individuals with upper-limb amputations in terms of quality-adjusted life years (QALYs) and subjective neuroma pain (NP) and phantom limb pain (PLP). Methods A retrospective single-center study assessed patient-reported outcome measures in postoperative TMR patients. Digital records were analyzed, and telephone interviews were conducted for all patients over an 8-year period. Results Significant reductions were observed in NP (−3.9, P < 0.01) and PLP (−4.9, P < 0.01), as well as an improvement in VAS scores (pre-TMR mean = 60.7, post-TMR mean = 76.3, P < 0.01) and pain scores (pre-TMR mean = 3.6, post-TMR mean = 2.5, P < 0.01) on the Euroqol EQ5D-5L scale. Conclusions We observed significant improvements in NP and PLP after TMR surgery, as well as improved pain scores on the EuroQol EQ5D-5L scale. This suggests that TMR may represent a reasonable management option for patients with nerve-related pain after an upper-limb amputation. More work needs to be done in the form of randomized controlled studies and economic analyses to quantify benefit and scalability. Clinical Relevance This article adds to the body of evidence in support of the potential important role of TMR in the management of chronic pain after upper-limb amputations.

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Section: Discussionmentioning

confidence: 99%

An Analysis of Pain and Quality of Life in Patients Undergoing Targeted Muscle Reinnervation After Upper-Limb Amputations

Zargaran,

Nagra

et al. 2024

J Prosthet Orthot

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“…organizaciones ha logrado reducir costos y obtener mejores resultados, lo que sugiere una mejora de la calidad de atención del paciente y/o la satisfacción de las personas 1 . Se apoya sobre tres pilares básicos: la medicina basada en la evidencia, la atención centralizada en el paciente, y la sustentabilidad 2 .…”

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Papel de la persona navegadora del paciente en el cáncer de pulmón

Smith,

Raices,

Pollán

et al. 2023

Rev. Hosp. Ital. B.Aires

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Introducción: la medicina basada en el valor ha logrado mejorar la calidad de atención del paciente y/o la satisfacción de las personas, reduciendo costos y obteniendo mejores resultados. Se apoya sobre tres pilares básicos: la medicina basada en la evidencia, la atención centralizada en el paciente, y la sustentabilidad. Sin embargo, existen pocas publicaciones sobre la estrategia de personas navegadoras para pacientes con cáncer de pulmón, que podrían ser una herramienta clave para brindar apoyo, asegurando que tengan acceso al conocimiento y los recursos necesarios a fin de completar la vía de atención clínica recomendada. Estado del arte: se trata de una intervención en salud cuyo objetivo principal es lograr vencer las barreras relacionadas con la atención (p. ej., logísticas, burocrático-administrativas, de comunicación y financieras) para poder mejorar la calidad y el acceso a la salud en el marco de la atención del cáncer. Estas personas cumplen un papel de guía para pacientes durante el proceso de diagnóstico y tratamiento activo. Su labor consiste en vincular al paciente con los proveedores clínicos, brindar un sistema de apoyo, asegurar un acompañamiento individualizado, garantizar que tengan acceso al conocimiento y a los recursos necesarios para completar el seguimiento y/o tratamiento adecuado. Discusión/Conclusión: indudablemente, es un elemento cada vez más reconocido en los programas de cáncer, centrado en el paciente y de alta calidad. Su implementación será de especial interés en la Unidad de Práctica Integrada para personas con cáncer de pulmón.

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What are the perspectives of patients with hand and wrist conditions, chronic pain, and patients recovering from stroke on the use of patient and outcome information in everyday care? A Mixed-Methods study

Arends,

Loos,

van Kooij

et al. 2024

Qual Life Res

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Purpose To evaluate the patients’ perspectives on the use of patient- and outcome information tools in everyday care and to investigate which characteristics affect general understanding and perceived value of patient- and outcome information. Methods This mixed-methods study included surveys and interviews on understanding, experience, decision-support, and perceived value in patients with hand and wrist conditions and chronic pain. We synthesized our quantitative and qualitative findings using a triangulation protocol and identified factors independently associated with general understanding and perceived value of patient- and outcome information using hierarchical logistic regression. Results We included 3379 patients. The data triangulation indicated that patients understand the outcome information, they find it valuable, it supports decision-making, and it improves patient-clinician interaction. The following variables were independently associated with better general understanding: having more difficulty with questionnaires (standardized odds ratio 0.34 [95%-CI 031–0.38]), having a finger condition (0.72 [0.57–0.92]), longer follow-up (0.75 [0.61–0.91]), and undergoing surgical treatment (ref: non-surgical treatment, 1.33 [1.11–1.59]). For more general value, these were: having more difficulty with questionnaires (0.40 [0.36–0.44]), having a wrist condition (0.71 [0.54–0.92]), better hand function (1.12 [1.02–1.22]), and requiring help with questionnaires (1.65 [1.33–2.05]). Conclusion Patients value the use of patient- and outcome information tools in daily care and find it easy to understand. The factors associated with understanding and value can be targeted to personalized and value-based healthcare. We recommend using outcome information to improve patient independence, empowerment, and involvement in decision-making.

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Value-Based Health Care in Hand Surgery: Where Are We & Where Do We Go From Here?

Cited by 6 publications

References 17 publications

An Analysis of Pain and Quality of Life in Patients Undergoing Targeted Muscle Reinnervation After Upper-Limb Amputations

An Analysis of Pain and Quality of Life in Patients Undergoing Targeted Muscle Reinnervation After Upper-Limb Amputations

Papel de la persona navegadora del paciente en el cáncer de pulmón

What are the perspectives of patients with hand and wrist conditions, chronic pain, and patients recovering from stroke on the use of patient and outcome information in everyday care? A Mixed-Methods study

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