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  • Measure Summary
  • NQMC:010981
  • Apr 2008

Pulmonary resection: percentage of patients undergoing pulmonary resection who have documentation of the use of postoperative incentive spirometry.

Cassivi SD, Allen MS, Vanderwaerdt GD, Ewoldt LL, Cordes ME, Wigle DA, Nichols FC, Pairolero PC, Deschamps C. Patient-centered quality indicators for pulmonary resection. Ann Thorac Surg. 2008 Sep;86(3):927-32. [40 references] PubMed External Web Site Policy

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients undergoing pulmonary resection who have documentation of the use of postoperative incentive spirometry.

Rationale

More than 30,000 patients undergo pulmonary resection (not including diagnostic lung biopsies) each year in the United States (Memtsoudis et al., 2006). Despite this large number of surgical procedures, there remain to date no standard criteria to measure the quality of care received by patients undergoing pulmonary resection. The general thoracic surgical team developed an a priori set of patient-centered quality of care measures, specific to patients undergoing pulmonary resection.

The use of postoperative incentive spirometry, as part of appropriate postoperative respiratory therapy, has been promoted since the 1980s (O'Donohue, 1985). Although numerous studies have investigated the role of incentive spirometry after abdominal surgery, relatively few have been published after thoracotomy. That is likely because of the general acceptance of this modality, on its own merits, or more recently as part of a structured postthoracotomy respiratory physiotherapy regimen (Weiner et al., 1997).

Evidence for Rationale

Cassivi SD, Allen MS, Vanderwaerdt GD, Ewoldt LL, Cordes ME, Wigle DA, Nichols FC, Pairolero PC, Deschamps C. Patient-centered quality indicators for pulmonary resection. Ann Thorac Surg. 2008 Sep;86(3):927-32. [40 references] PubMed External Web Site Policy

Memtsoudis SG, Besculides MC, Zellos L, Patil N, Rogers SO. Trends in lung surgery: United States 1988 to 2002. Chest. 2006 Nov;130(5):1462-70. PubMed External Web Site Policy

O’Donohue WJ Jr. National survey of the usage of lung expansion modalities for the prevention and treatment of postoperative atelectasis following abdominal and thoracic surgery. J Thorac Cardiovasc Surg. 1997 Mar;113(3):552-7. PubMed External Web Site Policy

Weiner P, Man A, Weiner M, Rabner M, Waizman J, Magadle R, Zamir D, Greiff Y. The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. J Thorac Cardiovasc Surg. 1997 Mar;113(3):552-7. PubMed External Web Site Policy

Primary Health Components

Pulmonary resection; postoperative incentive spirometry

Denominator Description

All patients undergoing pulmonary resection (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Documentation of postoperative incentive spirometry use

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

All ages

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

January through December

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Diagnostic Evaluation

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients undergoing pulmonary resection

This includes all patients undergoing pneumonectomy, lobectomy, segmentectomy, sleeve resection, and wedge resection, as well as thoracoscopic or open lung biopsy.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Documentation of postoperative incentive spirometry use

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Postoperative incentive spirometry.

Measure Collection Name

Patient-Centered Quality Indicators for Pulmonary Resection

Submitter

Division of General Thoracic Surgery, Mayo Clinic - Nonprofit Research Organization

Developer

Division of General Thoracic Surgery, Mayo Clinic - Nonprofit Research Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Stephen D. Cassivi, MD, MS; Mark S. Allen, MD; Gregg D. Vanderwaerdt, MPA; Lori L. Ewoldt, RN; Mary E. Cordes, RN; Dennis A. Wigle, MD, PhD; Francis C. Nichols, MD; Peter C. Pairolero, MD; Claude Deschamps, MD

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2008 Apr

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

Cassivi SD, Allen MS, Vanderwaerdt GD, Ewoldt LL, Cordes ME, Wigle DA, Nichols FC, Pairolero PC, Deschamps C. Patient-centered quality indicators for pulmonary resection. Ann Thorac Surg. 2008 Sep;86(3):927-32. [40 references] PubMed External Web Site Policy

Measure Availability

Source available from the Annals of Thoracic Surgery Web site External Web Site Policy.

For more information, contact Dr. Stephen Cassivi at the Mayo Clinic, 200 First St. SW, Rochester, MN, 55905; E-mail: cassivi.stephen@mayo.edu.

NQMC Status

This NQMC summary was completed by ECRI Institute on January 10, 2017. The information was not verified by the measure developer.

Copyright Statement

Reprinted from The Annals of Thoracic Surgery, Vol. 86, Issue 3, Cassivi SD, Allen MS, Vanderwaerdt GD, Ewoldt LL, Cordes ME, Wigle DA, Nichols FC, Pairolero PC, Deschamps C, Patient-centered quality indicators for pulmonary resection, 927-33, Copyright (2008), with permission from Elsevier.

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