Back to 2025 Abstracts
Development of International Quality Measures Targeting Low-Value Hand Surgery Conditions
Emily A Schultz, BS
1; Robin N Kamal, MD
1; Hand Surgery Quality Consortium, HSQC
1; Lauren M Shapiro, MD
21Stanford University, Redwood City, CA; 2University of California, San Francisco, San Francisco, CA
Introduction: Low-value care, care that may be unnecessary or care in which there is no evidence of benefit, persists in hand and upper extremity care across the world. To date, there are no quality measures to address low value care for a global setting. We hypothesized that international quality measures may be deemed important, feasible, usable, and scientifically acceptable for reducing low-value care for hand surgical conditions.
Methods: We performed a literature review to identify areas of potential low-value practice for hand surgical care. A consortium of eleven United States (US)-based surgeons with experience in hand and upper extremity surgery and/or quality measure development completed a modified RAND/UCLA Delphi Appropriateness process to evaluate the importance, feasibility, usability, and scientific acceptability of ten candidate quality measures to reduce low-value hand surgical care. A modified RAND/UCLA Delphi Appropriateness process was subsequently conducted that included a panel of 20 international hand surgeons who voted on the same ten measures utilizing the same voting criteria. Panelist agreement or disagreement was assessed using predetermined criteria.
Results: US and international panelists achieved agreement on the four criteria for five of the ten measures and thus these five measures were deemed valid. These measures include minimizing the unnecessary use of immobilization for fifth metacarpal neck fractures, post-injury imaging of distal radius fractures, peri-operative antibiotics for soft tissue hand surgery, pre-operative testing (e.g. CBC, CXR, EKG), and opioid use after hand surgery. Two additional measures were deemed valid by the US panelists only (minimizing the unnecessary use of concomitant wrist arthroscopy for distal radius fractures and post-operative hand therapy) and two measures were deemed valid by the international panel only (minimizing the unnecessary use of thumb spica for non/minimally displaced scaphoid waist fractures and increasing the utilization of wide awake local anesthesia no tourniquet for common low-risk hand surgeries).
Conclusion: Using a validated consensus-based approach, US- and internationally-based hand and upper extremity surgeons achieved consensus on an international quality measure portfolio to reduce low-value hand surgical care. These quality measures may be used across the globe to reduce low-value care in many types of health systems.
Back to 2025 Abstracts
