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Current concept review: quality and process improvement in orthopedics

Authors Pinney S, Page A, Jevsevar D, Bozic K

Received 11 July 2015

Accepted for publication 7 October 2015

Published 23 December 2015 Volume 2016:8 Pages 1—11

DOI https://doi.org/10.2147/ORR.S92216

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Jiabing Fan

Peer reviewer comments 2

Editor who approved publication: Professor Clark Hung


Video abstract presented by Stephen J Pinney

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Stephen J Pinney,1 Alexandra E Page,2 David S Jevsevar,3 Kevin J Bozic4

1Department of Orthopaedic Surgery, St Mary's Medical Center, San Francisco, CA, USA; 2Orthopaedic Surgery, AAOS Health Care Systems Committee, San Diego, CA, USA; 3Department of Orthopaedics, Geisel School of Medicine, Dartmouth University, Hanover, NH, USA; 4Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX, USA


Abstract: Multiple health care stakeholders are increasingly scrutinizing musculoskeletal care to optimize quality and cost efficiency. This has led to greater emphasis on quality and process improvement. There is a robust set of business strategies that are increasingly being applied to health care delivery. These quality and process improvement tools (QPITs) have specific applications to segments of, or the entire episode of, patient care. In the rapidly changing health care world, it will behoove all orthopedic surgeons to have an understanding of the manner in which care delivery processes can be evaluated and improved. Many of the commonly used QPITs, including checklist initiatives, standardized clinical care pathways, lean methodology, six sigma strategies, and total quality management, embrace basic principles of quality improvement. These principles include focusing on outcomes, optimizing communication among health care team members, increasing process standardization, and decreasing process variation. This review summarizes the common QPITs, including how and when they might be employed to improve care delivery.



Keywords: clinical care pathway, musculoskeletal care, outcomes, quality management, six sigma, lean thinking

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