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April 2013
PIM
More recently, the AHNS quality measures have been used to develop the first PIM in otolaryngology that fulfills one of the ABOto’s MOC requirements. According to Dr. Weber, who chairs the ABOto MOC committee, the AHNS quality measures are appropriate for the PIM because they indicate the best quality of care identified for oral cavity cancers. Physicians can use the measures to analyze their practice, find areas needing improvement, implement changes to improve those areas and retest their practice based on the changes made. This is a classic performance improvement methodology, he said, and one that fulfills Part IV of the MOC requirements.
The aim of the PIM is to provide feedback to physicians on their strengths as well as on areas that need improvement in a given clinical area, said Dr. Miller. “The PIMs are not meant to be punitive,” he said.
The PIM consists of three stages, he said: A, B and C. In stage A, physicians enter patient information, based on the AHNS quality measures, into a registry. The information is de-identified, said Dr. Miller, so that the patient is anonymous and the focus is only on the quality measures. Currently, physicians are asked to submit information on 10 patients with oral cavity cancer.
Once stage A is completed, physicians receive feedback on how they are doing based on the quality measures. This is stage B, and each physician’s performance is shown as it compares with other head and neck surgeons and all physicians who complete the PIM (including physicians other than head and neck surgeons), as well as the AHNS quality measures.
In the final stage (C), physicians are asked to enter a new series of five patients that indicate the changes made based on the feedback in stage B. In an ideal world, the changes would be tracked to see if physicians improve after going through this quality improvement process, said Dr. Miller, adding that the current focus is to encourage physicians to participate in the hope that they will meet the quality measures and show improvement.
As of the time this article was written, he said, about a dozen people have accessed the ABOto website to participate. Eventually, the ABOto plans to develop two or three more PIMs in each practice focus area, including otology, laryngology, rhinology and pediatric laryngology. Among the PIM topics currently in production are rhinosinusitis and allergy immunotherapy. The board has also identified other quality measures needed, including parotidectomy, thyroidectomy, dysphagia, subglottic stenosis, tympanoplasty, pediatric hearing loss assessment, conductive hearing loss, aging face, nasal deformity, facial trauma, chronic sinusitis, adult sleep disorder and pediatric sleep disorder.