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

45. Value-Based Clinical Quality Improvement for Chronic Groin…
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with the surgical treatment for this problem. A set of patient education
documents is given to the patient and family and includes a basic education
summary for this problem, a group of frequently asked questions
(FAQs) generated by former patients for the entire cycle of care, and a
copy of a book chapter on this problem with a description of surgical
treatments. Patients and family members are encouraged to do their own
research, to talk with other patients, and to consider other opinions,
including from other surgeons who are considered experts in this area.
In this model, we also define outcome measures that determine the
value of care (quality, safety, satisfaction, etc.). These measures are
obtained based on the subjective and objective input from a multidisciplinary
hernia team, including the patient and family. As part of CQI, the
hernia team enters into a data-sharing contract that allows the deidentified
patient information to be shared with others who could add
value to the process of interpreting the data and might contribute ideas
for improved care. In addition to the core hernia team members, business
operations specialists, engineers, and associates from the manufacturers
of drugs and devices used in the care of this patient group can potentially
contribute ideas and knowledge to improve the outcomes for this CQI
program. As a part of the CQI program, a group of volunteer patient and
family members, surgical residents, medical students, and other general
surgeons may also participate at various times to add their perspective to
the improvement process. This can occur through participation at regularly
scheduled CQI meetings. The primary objective of this CQI program
is for the improvement of value for the patient within the local care
process. Secondary goals may include sharing this de-identified data and
analysis with hospitals, other physicians, patients, medical device companies,
regulatory bodies, and others within the healthcare value stream.
Implementing CQI as a part of the actual patient care process allows for
the coordination of care and quality improvement efforts to be exempt
from the strict requirements of the Health Insurance Portability and
Accountability Act (HIPAA), and the effort is not required to go through
an Institutional Review Board (IRB) process [ 13 ].
The process of developing a CQI program for patients with chronic
pain after hernia repair will initially be limited to those hernia practices
that regularly treat this patient group. However, the data and analytics
that are generated from these specialized hernia programs can be shared
with any surgeon, hospital, or person with chronic pain after hernia
repair that could benefit from access to this information. A sample worksheet
that could be used to generate a CQI program for this condition is
presented in Fig. 45.1 .