Act Locally: Quality and Safety in Head and Neck Care

The best care is provided by an experienced and collaborative multidisciplinary team made up of head and neck surgeons, radiation oncologists, and medical oncologists who are supported by allied health care providers who focus on all aspects of the patient’s care and rehabilitation. The electronic medical record (EMR) provides comprehensive data for a particular patient and the patient’s disease that are readily available to all members of the multidisciplinary treatment team. Transfer of important data is vitally important in medical decision making. The use of pathology templates to convey important pathologic information to the treating physicians allows appropriate decision making based on complete pathologic data. These pull-down menus populate fields that are critical to the management of an individual head and neck cancer patient. Complete pathologic data prevents errors of omission.

Effective perioperative pathways that streamline care and track outcome data for continuous quality improvement of head and neck cancer care have been developed through a collaborative and multidisciplinary approach, and are generally followed. The goals of these pathways include diminishing variation and omission of care, minimizing length of stay, decreasing resource utilization, prospectively managing comorbidity, reducing complications, and providing patient- and family-centered education.

The American Head and Neck Society (AHNS) Quality Committee and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) are working collaboratively to develop global quality measures that will improve the care of patients with neoplastic and non-neoplastic diseases of the head and neck. Because head and neck cancer care today is multidisciplinary, the AHNS will also work with the American Society for Therapeutic Radiology and Oncology (ASTRO) and the American Society of Clinical Oncology (ASCO) to develop quality oncology performance indicators (QOPI™) (www.asco.org ).

Randal S. Weber, MD

The goal of QOPI is to promote excellence in cancer care by helping practices create a culture of self-examination and improvement. The process employed for improving cancer care includes measurement, feedback, and improvement tools for medical oncology practices. Certain benchmarks, which are global but also disease- and discipline-specific, must be met. For the head a neck surgical oncologist, quality outcome measures include length of stay, transfusion, perioperative mortality, readmissions within 30 days, return to the operating room, and surgical margins.

Additionally, Dr. Weber recommended the creation of a peer review process to evaluate the performance of the multidisciplinary team and the institutions that care for patients with head and neck cancer. Global quality indicators are local regional disease control, overall survival, treatment package time, treatment-related mortality, unplanned hospitalizations, and patient satisfaction. Performance for these quality parameters can be assessed through site visits and focused case reviews. Results of these evaluations and disease outcomes (with acuity adjustment) should be transparent-that is, available and accessible in the public domain. EMRs will be necessary to track all of these clinical data, which are becoming fundamental for assessing, rating, and reporting provider and institutional performance.