Improving Surgery Outcomes and Reaching the Poorest with Surgical Care
HAS is working with researchers from the Center for Surgery and Public Health at Brigham and Women’s Hospital and Harvard Medical School to monitor outcomes on the HAS surgical service, including surgical site infections (SSI), unplanned return to the operating room, all-cause mortality, and post-operative mortality. Secondary outcomes include delay to operation and length of stay. According to lead researcher Alexi Matousek MD, MPH, this study will be one of the few efforts in the literature that evaluates surgical outcomes in a low-resource setting.
To date, 1,100 patients have been enrolled in the study and interim analyses show an impressively low overall SSI rate by international standards of 2.9%, but a long length of stay for patients requiring wound care. We hope this effort will lead to future quality improvement efforts and reductions in cost at HAS.
HAS is also doing research to help improve patient access to surgical care, regardless of patient income. The poorest members of the HAS district living in mountainous areas do not access surgical care at the same rate as higher-income patients living in the valley. While the HAS social service program provides free care for the indigent, it is under-utilized by the mountain patients. Patients from the valley areas closest to the hospital receive approximately 13.8 operations per 10,000 population compared to just 3.7 operations per 10,000 mountain patients. To address this disparity, HAS has trained patient navigators to guide pre-screened patients from the mountains through the hospital system. This program started in March, 2014, and has enjoyed early success, demonstrating a 15-fold increase in elective operations for the mountain population in an interim analysis.
“We anticipate the patient navigators will significantly increase the surgical service rate among this disadvantaged population and provide a model for the social service program to reach its full potential in providing equity for the patients of HAS,”
– Dr. Herriot Sannon, HAS Medical Director
With Dr. Matousek, HAS is conducting an innovative pilot program for the early detection of surgical site infections among post-operative patients who have been discharged. HAS has trained and equipped community health workers in the HAS service area to use durable smart phones to perform home visits on surgical patients, complete a survey on symptoms of SSI and take a quality photograph of the incision site. The pilot program started on April 1, 2014, and 30 patients have received home visits to date. This program will form the foundation for future outpatient outcomes studies in Haiti and perhaps inform cost reduction efforts in the United States through a successful example of task shifting.