Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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B. Ramshaw
The information generated by the care processes can be used to improve
the outcomes of care over time. This continuous improvement of the
patient’s entire cycle of care has the potential to lead to improved quality,
safety, and patient satisfaction at the same time that costs are lowered,
resulting in improved value [ 1 , 2 ].
The clinical quality improvement (CQI) program described in this
chapter demonstrates an attempt at process improvement for patients
with chronic groin pain after inguinal hernia repair. With chronic groin
pain after inguinal hernia repair becoming a more common and sometimes
devastating problem, there is an opportunity to significantly
improve the outcomes for this group of hernia patients and decrease the
costs of care for this patient group, thus increasing overall value.
Traditionally, improvements in patient care have been dependent on
established clinical research tools such as prospective randomized controlled
studies. However, using traditional research tools for a complex
dynamic process—such as for a patient with chronic pain after hernia
repair—with inherent uncontrollable variables can be inadequate to
improve value for patients. Recently, principles of CQI have been introduced
to improve clinical care. The value of applying these principles
has already been established for a portion of a patient’s cycle of care:
reducing central line infection, for example [ 10 ]. Implementing the principles
of CQI for the entire cycle of care for patients who develop
chronic pain after abdominal wall (inguinal and ventral) hernia repair
has not yet been demonstrated. A comparison between traditional clinical
research and CQI is presented in Table 45.1 .
Methods: Developing a CQI Program for Patients
with Chronic Pain After Hernia Repair
Using principles of complex systems science and tools such as CQI
programs and nonlinear data analytics (such as predictive analytics), we
can define a variety of patient groups who had abdominal wall hernia
disease and related complications, such as chronic pain after hernia
repair. We have constructed a diverse hernia team to serve the needs of
this patient group. Based on feedback from former patients and review of
current literature, a dynamic care process is defined for the entire cycle
of care, from the moment of first symptom or contact until full return to
a maximum quality of life, with ongoing contact for long-term follow-up.
One step in the process is to determine the factors involved in producing
various outcomes. In reviewing the literature, two sources have produced