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Application of Outcome Measures in International Humanitarian Aid: Comparing Indices through Retrospective Analysis of Corrective Surgical Care Cases

Published online by Cambridge University Press:  28 June 2012

K.A. Kelly McQueen ,
William Magee ,
Thomas Crabtree ,
Christopher Romano  and
Frederick M. Burkle Jr.
K.A. Kelly McQueen*
Affiliation:
Harvard Humanitarian Initiative, Harvard School of Public Health, Boston Massachusetts, USA
William Magee
Affiliation:
Operation Smile International, Norfolk, Virginia, USA
Thomas Crabtree
Affiliation:
Tripler Army Medical Center, US Pacific Command, Honolulu, Hawaii, USA
Christopher Romano
Affiliation:
Harrington Department of Bioengineering, Arizona State University, Tempe, Arizona, USA
Frederick M. Burkle Jr.
Affiliation:
Harvard Humanitarian Initiative, Harvard School of Public Health, Boston Massachusetts, USA
*
4134 N 49th PlacePhoenix, Arizona 85018USA E-mail: kamcqueen@gmail.com
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Abstract

It is common for international organizations to provide surgical corrective care to vulnerable populations in developing countries. However, a current worsening of the overall surgical burden of disease in developing countries reflects an increasing lack of sufficient numbers of trained healthcare personnel, and renders outside volunteer assistance more desirable and crucial than ever. Unfortunately, program evaluation and monitoring, including outcome indices and measures of effectiveness, is not measured commonly. In 2005, Operation Smile International implemented an electronic medical record system that helps monitor a number of critical indices during surgical missions that are essential for quality assurance reviews. This record system also provided an opportunity to retrospectively evaluate cases from previous missions. Review of data sets from >8,000 cases in 2005 and 2006 has provided crucial information regarding the priority of surgery, perioperative and operative complications, and surgical program development.

The most common procedure provided was unilateral cleft lip repair, followed closely by cleft palate. A majority of these interventions occurred for patients who were older than routinely provided for in the western world. The average child treated had an age:weight ratio at or below the [US] Centers for Disease Control and Prevention (CDC) 50th percentile, with a small percentage falling below the CDC 20th percentile. A majority of children had acceptable levels of hemoglobin, but the relative decreased age:weight ratio nonetheless can reflect mild malnutrition. Complications requiring medical intervention were seen in 1.2% of cases in 2005 and 1.0% in 2006. Thirty percent were reported as anesthesia complications, and 61% reported as surgical complications. One death was reported, but occurred after discharge outside the perioperative period. Complication rates are similar to rates reported in the US and UK and emphasizes the importance of standardization with uniform indices to compare quality performance and equity of care. This study offers an important example of the importance of collecting, analyzing, and reporting measures of effectiveness in all surgical settings.

Keywords

cleft lipcleft palatehumanitarian aidOperation Smile Internationalrecoverysurgical care
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 24 , Issue 1 , February 2009 , pp. 39 - 46
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

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