Get Ready for Quality Improvement: Panelists outline helpful metrics and more

Scharukh Jalisi, MD, director of head and neck oncologic and skullbase surgery at Boston University School of Medicine in Boston, emphasized the importance of tracking physician performance. “The key for ongoing physician performance is to look for improvement,” he said. “It is not a witch hunt.”

The need for physicians and institutions to get on board to develop metrics appropriate to otolaryngology is critical, because these metrics will be increasingly used by patients to select care and by payors to determine reimbursement.

“We need to be prepared for increased transparency and the need for individual practitioners and hospitals to report performance metrics for their medical staff in the coming years,” Dr. Shah said. “Not only is this a Joint Commission requirement, it is being demanded by the public and, soon, the payors.”

How to Prepare

To help physicians and institutions prepare to implement quality improvement, Dr. Nussenbaum provided a list of recent research articles on quality improvement that are relevant to the everyday practice of otolaryngologists and head and neck surgeons (See “Key Studies on Quality Improvement,” page 4).

Of these, he described in detail a 2010 study on quality and performance indicators in an academic department of head and neck surgery in which the authors described a method for assessing physician performance and care outcomes adjusted for procedure acuity and patient comorbidity (Arch Otolaryngol Head Neck Surg. 2010;136:1212-1218). The study also identified best practices and developed a monitoring tool to identify trends that require intervention to improve quality of care.

The model proposed in the study, said Dr. Nussenbaum, allows surgeons to assess individual outcomes in relation to their peers, identify best practices and positively affect patient outcomes through self-improvement. He said that the risk adjustment included in the model, which took into consideration both acuity of surgery and patient comorbidities, had a significant impact and was an important consideration for analyzing the data.

“The model appears to be a useful tool, and this model could potentially be applicable to other specialty practices,” he said.

Randal S. Weber, MD, the lead author of the study who was attending the session, commented that he and his colleagues are continuing to look at trends in the data and hope to see surgeons tend toward the mean but will track outliers to modify practice. Dr. Weber, professor of head and neck surgery at the University of Texas MD Anderson Cancer Center in Houston, also said that other risk factors, such as disease stage and prior treatment, may need to be incorporated into the model.