Defining Quality in Otolaryngology with New Measures

November 2017 – Vol. 36, No. 10

The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) is dedicated to the development and implementation of clinically valid performance measures, which contribute to success in quality of care for otolaryngologist-head and neck surgeons.

With this goal in mind, the Foundation has been working around the clock to develop meaningful and relevant quality measures available to AAO-HNS members through Reg-entSM, the Academy’s qualified clinical data registry. These measures in development will expand the number of overall measures available to all specialties within the Academy.

In July, the Foundation convened two, in-person measure development group (MDG) meetings to discuss quality measures. The first meeting entailed the development of de-novo measures on Age-related Hearing Loss (ARHL) Measures. The second meeting convened discussions of Jumpstart Measures, which are based on the clinical practice guidelines. The MDG’s directive was to define new measures for quality improvement (QI) and for use in Reg-ent.

ARHL Measures were prioritized as an important public health issue by the Reg-ent Executive Committee (REC) and Clinical Advisory Committees (CAC) for measures development due to the paucity of data available from guidelines, randomized controlled trials, large epidemiological studies, or other research to explicitly support these measures.

The MDG, led by Richard K. Gurgel, MD (Chair), Selena E. Briggs, MD, MBA, PhD (Co-Chair), and Richard M. Rosenfeld, MD, MPH, (Methodologist) is comprised of cross-specialty, multidisciplinary representatives, including the following relevant stakeholder groups: AAO-HNSF Board of Governors (BOG), AAO-HNSF Section for Residents and Fellows (SRF), AAO-HNSF General and Sleep CAC, American Otological Society (AOS), American Society of Geriatric Otolaryngology (ASGO), American College of Physicians (ACP), American Geriatrics Society (AGS), Agency for Healthcare Research & Quality (AHRQ), American Neurological Society (ANS), American Speech-Language-Hearing Association (ASHA), and consumer representatives from American Association of Retired Persons (AARP) and the National Center for Health Research (NCHR).

ARHL Measures represent the Foundation’s first independent effort to lead the development of quality measures with a multidisciplinary MDG. The Foundation intends to incorporate four ARHL measures into Reg-ent to be available for public reporting, gather data on gaps in care, to identify opportunities for improvement, and to assess measure feasibility and reliability. Future efforts in this area may focus on additional relevant conditions or outcomes for the practice of otolaryngology.

Project Jumpstart Measures prioritizes topics on Bell’s palsy, otitis media with effusion, tympanostomy otorrhea, and dysphonia after thyroidectomy, which are based on the AAO-HNSF clinical practice guideline key action statements.

The MDG led by Dr. Rosenfeld (Chair/Sr. Advisor Guidelines and Measures, ex-officio REC) includes the following Academy members: Lauren S. Zaretsky, MD (Chair, General & Sleep CAC, REC member), Stacey L. Ishman, MD, MPH (then Chair, BOG), Lawrence (Larry) M. Simon, MD [Physician, Payment, Policy (3P) Advisor], and Peter M. Vila, MD, MSPH (then Chair, Section for Residents and Fellows in-Training).

The MDG developed five measures that focus on Bell’s palsy, otitis media with effusion, tympanostomy otorrhea, and dysphonia after thyroidectomy topics, which are areas specific to the practice of otolaryngology-head neck surgeons. These measures will be utilized for quality improvement, used in the AAO-HNSF’s qualified clinical data registry (QCDR) Reg-ent, and be considered for use in accountability programs, such as the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP) under the Merit-based Incentive Payment System (MIPS).

The Jumpstart Measures represent a new stage in AAO-HNSF’s efforts to develop evidence-based quality measures that actively seek to improve patient care and outcomes. Future efforts in this area may focus on additional relevant conditions or outcomes for the practice of otolaryngology-head neck surgeons.

The Foundation invited Academy members and relevant stakeholders to review the ARHL and Jumpstart measures in development and to provide comments. The purpose of the comment period was to seek feedback before the measurement set is finalized. It is an opportunity to make any necessary refinements during the measurement development process. Public comment period for these measures concluded October 1.

In collaboration with other institutes and specialty societies, the Foundation is working to develop additional measures. They include topics such as allergic rhinitis, cerumen impaction, neurotology, and rhinoplasty.

The Foundation is currently partnering with the ECRI institute on GEM-Cutting and e-specification of quality measures derived from the Allergic Rhinitis and Cerumen Impaction Clinical Practice Guidelines. These measures have undergone review by our physician experts and are being prepared for public comment.

In collaboration with the American Association of Neurology (AAN) on the development of Neurotology quality measures, the Foundation has nominated three representatives to this panel: Erica A. Woodson, MD, Habib M. Rizk, MD, MSc, and Marc L. Bennett, MD. Stewardship of these measures will be handled jointly by both organizations. These measures are soon to start undergoing public commenting and testing for use in both the AAN’s and AAO-HNSF’s registries.

Convening this fall, the Foundation will be collaborating with the American Society of Plastic Surgery (ASPS) and the American Academy of Facial Plastics Reconstructive Surgery (AAFPRS) on the development of Rhinoplasty measures. The Foundation nominated four representatives to participate in this measures development partnership with the ASPS and AAFPRS: Lisa E. Ishii, MD, MHS, Travis T. Tollefson, MD, MPH, Benjamin C. Marcus, MD, and Oren Friedman, MD.

AAO-HNSF measures in development are an ongoing process. New measures pertinent to otolaryngologists will continually be evaluated and incorporated into Reg-ent. If you have additional questions on measures in development, please email qualityimprovement@entnet.org.