Cultura

Beyond Process TO Patient Outcomes: A Comprehensive Scoping Review Exploring THE Evolution, Operationalization, Implementation Challenges, Enabling Factors, AND Demonstrable Impact OF Continuous Quality Improvement IN Complex Healthcare Environments

VOLUME 21, 2024

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Abdullah Omran Omar Alluhaybi, Bassam Mejeb Awidh Almutari, Mai Dhafer Alqahtani, Yousef Bakheet Marzouq Almayhubi, Omar lafi olaythah alhejaili, Khalaf Ibrahim Albalawi, Mohammed Eid Al-Hawiti
Salman Eid Fadhi Alhejaili, ‏Mohammed Faraj Albalawi, ‎ Asim Mohammed Aleidi Abonuua, Ahmed Mobel Alenezi, ‎ Ahmed Ibrahim Albushi, Nasser Mohammed Al-Mutairi

Abstract

Continuous Quality Improvement (CQI) has emerged as a cornerstone methodology for enhancing healthcare delivery systems globally. Despite its widespread adoption, significant variations exist in how CQI is conceptualized, implemented, and evaluated across healthcare settings. This scoping review synthesizes the existing literature on CQI in healthcare to map its evolution, explore its operationalization frameworks, identify implementation challenges and enablers, and assess its demonstrable impact on patient outcomes and system performance. Using the Arksey and O'Malley framework, supplemented by recent PRISMA-ScR guidelines, this review examines the multifaceted nature of CQI implementation in complex healthcare environments and highlights critical gaps in current understanding. Findings reveal a progressive shift from process-focused metrics toward patient-centered outcome measures, though significant barriers to effective implementation persist. The review identifies key enabling factors that facilitate successful CQI integration and documents evidence of positive impacts on clinical, operational, and experiential dimensions of care. These insights provide a comprehensive foundation for healthcare leaders, practitioners, and policymakers to advance CQI initiatives that genuinely transform healthcare delivery and improve patient outcomes.

Keywords : .
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty