San Francisco, Calif.—Close on the heels of the evidence-based medicine movement comes increasing pressure for physicians and health care institutions to develop and implement quality improvement measures that will not only improve quality of care, but also reduce medical costs and provide a way to measure performance by physicians and institutions. Integral to this process is the development of appropriate metrics by which to measure outcomes and physician performance that accurately reflect otolaryngology and its subspecialties. Two sessions at the recent 2011 American Academy of Otolaryngology–Head and Neck Surgery Annual Meeting held here Sept. 13 highlighted issues that are important for otolaryngologists striving to meet the growing demand for quality improvement.
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October 2011
Bedrock of Quality Improvement
Among the external pressures on physicians and health care organizations to develop and implement metrics that can be used to evaluate outcomes are agencies such as the Joint Commission that require, through medical staffs, Ongoing Professional Practice Evaluations (OPPE) and Focused Professional Practice Evaluations (FPPE), according to Rahul K. Shah, MD, a pediatric otolaryngologist with Children’s National Medical Center at George Washington University Medical School in Washington, DC.
“Everyone in this room will have to help define our metrics and we’ll need to police ourselves,” he said, emphasizing that the onus is on otolaryngologists to develop appropriate metrics. These metrics, he said, must be consistent with the Joint Commission’s guidelines for developing OPPE and FPPE metrics. (For more information, see “Resources on the Joint Commission Standards for OPPE,”)
Brian Nussenbaum, MD, Christy J. and Richard S. Hawes III Professor and patient safety officer within the department of otolaryngology-head and neck surgery at Washington University School of Medicine in St. Louis, Mo., emphasized that the role of metrics is to identify areas of quality excellence and to identify areas for quality improvement. “These metrics should be indirect measures of quality of care,” he said. (See his “Characteristics of a Good Metric” on page 4.)
One major challenge for otolaryngology is to “choose metrics that are meaningful and applicable to otolaryngologists across a wide spectrum that might have very different subspecialty practices, especially in an academic department,” he said.
In 2009, Dr. Nussenbaum became the formal patient safety officer in his department and, in conjunction with Richard Chole, MD, PhD, Lindburg Professor and department chairman of otolaryngology-head and neck surgery at Washington University School of Medicine in St. Louis, Mo., initiated a comprehensive quality improvement process that includes OPPE and FPPE requirements. As part of that process, quality metrics are tracked using a computer program called Tableau, with the data provided quarterly by Barnes-Jewish Hospital in St. Louis, Mo. An OPPE is conducted every eight months on each attending physician, and the overall performance of the department is also tracked.