Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a m
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(2020) 20:247
RESEARCH ARTICLE
Open Access
Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach Heena P. Santry1,2,3* , Scott A. Strassels1,2, Angela M. Ingraham4, Wendelyn M. Oslock1,2, Kevin B. Ricci1,2, Anghela Z. Paredes1,2, Victor K. Heh1,2, Holly E. Baselice1,2, Amy P. Rushing1,2, Adrian Diaz1,2, Vijaya T. Daniel5, M. Didem Ayturk6 and Catarina I. Kiefe6
Abstract Background: Acute Care Surgery (ACS) was developed as a structured, team-based approach to providing roundthe-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. Lacking any prior evidence on optimizing outcomes for EGS patients, current implementation of ACS models has been idiosyncratic. We sought to use a Donabedian approach to elucidate potential EGS structures and processes that might be associated with improved outcomes as an initial step in designing the optimal model of ACS care for EGS patients. Methods: We developed and implemented a national survey of hospital-level EGS structures and processes by surveying surgeons or chief medical officers regarding hospital-level structures and processes that directly or indirectly impacted EGS care delivery in 2015. These responses were then anonymously linked to 2015 data from the American Hospital Association (AHA) annual survey, Medicare Provider Analysis and Review claims (MedPAR), 17 State Inpatient Databases (SIDs) using AHA unique identifiers (AHAID). This allowed us to combine hospital-level data, as reported in our survey or to the AHA, to patient-level data in an effort to further examine the role of EGS structures and processes on EGS outcomes. We describe the multi-step, iterative process utilizing the Donabedian framework for quality measurement that serves as a foundation for later work in this project. Results: Hospitals that responded to the survey were primarily non-governmental and located in urban settings. A plurality of respondent hospitals had fewer than 100 inpatient beds. A minority of the hospitals had medical school affiliations. (Continued on next page)
* Correspondence: [email protected] 1 Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, USA 2 Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's C
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