To develop the measures, Dr. Chen and her colleagues followed a process similar to those used to develop quality measures by larger organizations such as the American Cancer Society and National Quality Forum, but on a much smaller scale. They conducted a literature review and ranked the evidence, culling the highest evidence available, to come up with yes and no questions that reflected good quality of care.
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April 2013She emphasized, however, that these quality measures are not the same as clinical guidelines. “I view clinical guidelines as more of a cookbook: They tell you what to do, but they do not measure the process,” she said. “Quality measures measure the output of what you are doing, so they can be seen as on the backside of clinical guidelines, more like a report card.”
Randal S. Weber, MD, professor and chairman of the department of head and neck surgery at the University of Texas MD Anderson Cancer Center in Houston, who was also involved in initiating and developing the AHNS measures, described the quality measures as an extension of practice guidelines. “We have practice guidelines that are the best evidence available for treating oral cavity cancers, and the quality measures are really a measure of how well you are following those guidelines,” he said.
Physicians who want to measure how they are doing in managing patients with oral cavity cancers can complete a simple form that lists the key quality measures identified (available at ahns.info). AHNS members can use this form to obtain patient information, which is then entered into a database. The physicians are given feedback on how well they are adhering to each quality measure. Although Dr. Chen said that some physicians may find inputting the data burdensome, she emphasized that efforts are underway to make the system as user friendly as possible.
William Lydiatt, MD, professor and division chief of head and neck surgical oncology at the University of Nebraska Medical School in Omaha, whose division has adopted the AHNS quality measures, said that the measures are practical and can be implemented. “We started with a review of what we had been accomplishing and found that there were areas where we could improve,” he said, adding that one particular area that his division is working on improving is smoking cessation. For Dr. Lydiatt, one key issue is that the measures require significant resources, such as speech and swallowing therapy, and these can be time and personnel intensive.