Closing the loop: a 10-year experience with routine outcome measurements to improve treatment in hand surgery

Reinier Feitz*, Yara E. van Kooij, the Hand-Wrist Study Group, Marloes H.P. ter Stege, Mark J.W. van der Oest, J. Sebastiaan Souer, Robbert M. Wouters, Harm P. Slijper, Ruud W. Selles, Steven E.R. Hovius

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)
20 Downloads (Pure)


Routine outcome measurements as a critical prerequisite of value-based healthcare have received considerable attention recently. There has been less attention for the last step in value-based healthcare where measurement of outcomes also leads to improvement in the quality of care. This is probably not without reason, since the last part of the learning cycle: ‘Closing the loop’, seems the hardest to implement. The journey from measuring outcomes to changing daily care can be troublesome. As early adopters of value-based healthcare, we would like to share our 10 years of experience in this journey. Examples of feedback loops are shown based on outcome measurements implemented to improve our daily care process as a focused hand surgery and hand therapy clinic. Feedback loops can be used to improve shared decision making, to monitor or predict treatment progression over time, for extreme value detection, improve journal clubs, and surgeon evaluation. Our goal as surgeons to improve treatment should not stop at the act of implementing routine outcome measurements. We should implement routine analysis and routine feedback loops, because real-time performance feedback can accelerate our learning cycle.

Original languageEnglish
Pages (from-to)439-450
Number of pages12
JournalEFORT Open Reviews
Issue number6
Publication statusPublished - 28 Jun 2021

Bibliographical note

Funding Information:
We would like to thank all patients who have filled out questionnaires as part of their clinical care and who have agreed that their data could be anonymously used for the present study. In addition, we would like to acknowledge the members of the Hand-Wrist Study Group, caregivers and personnel of Xpert Clinics, Xpert Handtherapy and Equipe Zorgbedrijven for assisting in the routine outcome measurements that are the basis for this manuscript.

Publisher Copyright:
© 2021. All Rights Reserved.


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