“We wanted to take the situation and require that the doctor document reasons for prescribing. If they were prescribing inappropriately, this might engender concerns in their mind about their professional reputation, because, upon reflection, they would find themselves unable to give a good justification,” said Dr. Doctor. “We gave them the option to back out if they wanted to, or they could click on the screen and choose an alternative.” Accountable justification also helped lower overprescribing rates from 31% to 7%.
Explore This IssueSeptember 2017
Reg-ent to Help Improve Patient Care, Physician Training
How can peer comparison work in otolaryngology? In 2016, the American Academy of Otolaryngology-Head and Neck Surgery/Foundation introduced its Reg-ent system, a clinical data registry of information used to collect, store, retrieve, analyze, and disseminate information about different otolaryngology diseases, conditions, and outcomes.
Today, a year after it was opened to full clinician participation, the panel consists of 334 practices representing about 1,900 participants, said James C. Denneny III, MD, chair of the Reg-ent Executive Committee and the executive vice president and CEO of AAO-HNS/F. Peer comparison is already a Reg-ent feature, he said
“Reg-ent will allow participating physicians to compare their performances on self-selected quality measures to other physicians within their group as well as nationally,” though it is not searchable for specific physicians beyond one’s own practice, he said. Having comparison information will identify performance improvement measures, which the physician can then follow, document steps taken, and note how patient care is affected by such interventions.
How can Reg-ent help train otolaryngologists to be better at what they do? Analyzing the results of how various treatments are most effective will guide current and future otolaryngology training.
“The volume of registry-based data allows [us to see a] compressed timeline in the evaluation of different treatment modalities,” said Dr. Denneny. “We will know much sooner the results of various treatments and can adjust training for residents as well as those in practice. This also has the potential to broaden trainee experience well beyond their immediate faculty to practitioners in multiple settings across the country.” National and global results can help educate physicians beyond what they see in the clinical settings of their own hospitals. “This should benefit patients in the long run,” he added.
Maintenance of Certification
Part IV of the American Board of Otolaryngology’s (ABOto’s) Maintenance of Certification (MOC), which will address medical practice improvement, is still under development; the ABOto does not currently have a particular timeline for implementation of Part IV. But the idea of using peer comparison will be very effective, said David W. Eisele, MD, FACS, director of the department of otolaryngology-head and neck surgery and professor of oncology at Johns Hopkins Medical Center in Baltimore, and chair of the ABOto MOC committee.