Dr. Hilger added that there’s also the concept of maintenance of certification. Certifying boards are focusing on improving outcomes in your practice and being able to demonstrate this for recertification. A correlation to that is that over the next couple of years, states are going to a maintenance of licensure program that will use some of the same criteria we use for certification.
While the trend to improve and measure quality of care has been championed in recent years by the government, payers, providers, and patients, some surgeons may see Dr. Rhee’s Skin Cancer Index as promising but not yet validated.
I can see how it has some application in the future, but these are very preliminary findings, said Ira D. Papel, MD, Associate Professor at Johns Hopkins University and a member of the Facial Plastic Surgicenter in Pikesville, MD.
Noting that the purpose of the index is to develop normal values over time, Dr. Papel said that the researchers need to survey more than just a couple hundred people. This is something that has to be done over several thousand people over a lifetime. And then, when these values are developed, we may see new patients who fall outside of those normative values and may need some extra help.
Dr. Rhee said that he agrees with Dr. Papel in his assessment that this is just the beginning. We validated the instrument on a select subgroup of patients with NMSC. It is up to the larger scientific community to test it on other subgroups with NMSC. Though the Skin Cancer Index is a psychometrically validated QOL instrument, there is still a long way to go in terms of accumulating normative data and studying the breadth of the disease and its impact on patients.
For example, he added, we are using the Skin Cancer Index on a subgroup of patients with NMSC who are immunosuppressed due to previous solid organ transplantation. These patients have much more disease burden and potentially more serious consequences of the disease in terms of morbidity and mortality. It will be interesting to see how the index scores compare in this subgroup of higher-risk patients.
In the March 2007 issue of Laryngoscope, the researchers further explain their scoring system and describe how the preoperative responses of patients differed from their feelings postoperatively.