In the media and in scientific publications there is a growing interestin the quality of health care and possible differences in quality amonghospitals and doctors. Quality of care is important for patients whoreceive care and for doctors who deliver care. Central in thisdiscussion is the question how we should measure quality of care. Indicators may be helpful in measuring quality of care. In this study wedeveloped a set of indicators for orthopedic care in the hospital.The Dutch Health Care Inspectorate requested the National Institute forPublic Health and the Environment (RIVM) to develop this set ofindicators to support their inspection activities. This study wascarried out in close collaboration with the Dutch Society of OrthopaedicCare (NOV).To define a limited set of indicators for orthopedic care, three stepswere taken. The first step was a search of peer-reviewed articles whichdescibe indicators related to the outcome of orthopedic care. The secondstep was a consensus procedure among specialists in the field oforthopedics to define a limited set of relevant indicators. Thisresulted in a set of 24 indicators. In the third step, these indicatorswere studied in a feasibility study during four months in threehospitals. We evaluated the use of the indicators by means ofquestionnaires and interviews with personal of the hospitals. Finally aset of 13 indicators was selected for further implementation. The setconsists of indicators for the structure of care (time of surgery,availability of early discharge program, availability of ultra-clean airregulation), indicators for the process of care (participation ofdischarge paths, use of ultra clean air regulation, and preadmissionpatient education), and the outcome of care (deep vein thrombosis,pulmonary embolism, deep wound infection, urinary tract infection,dislocation, incidence of severe decubitus, and average length of stay). The evaluation study showed that registration of the indicators was notsatisfactory feasible with the method used. Further development of aregistration method and data-processing structure is necessary to makeimplementation of the indicators possible.
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