Otolaryngology–Head and Neck Surgery | 2021
Executive Summary: “Evidence-Based Performance Measures for Rhinoplasty: A Multi-disciplinary Performance Measure Set”
Abstract
P erformance measurement is intended to collect and evaluate health care data in an effort to improve the quality of decisions affecting all levels of health care delivery, including the recipient of the care. Patients undergoing rhinoplasty may need aesthetic or functional improvements or both. Rhinoplasty quality performance measures were developed in part to assess how these needs are met, which may include the following: (1) the quality of the procedure performed, (2) the surgeon’s observance of evidence-based guidelines of care, and (3) the extent to which the desired results were achieved for patient and surgeon. The evidence-based performance measures for rhinoplasty were created by the Rhinoplasty Performance Measurement Workgroup, a multidisciplinary collaboration among the American Society of Plastic Surgeons, the American Academy of Facial Plastic and Reconstructive Surgery, and the American Academy of Otolaryngology– Head and Neck Surgery (AAO-HNS). For the AAO-HNS, representation included Oren Friedman, MD, Lisa Ishii, MD, MHS, Benjamin Marcus, MD, and Travis Tollefson, MD, MPH; for the American Academy of Facial Plastic and Reconstructive Surgery, Fred G. Fedok, MD, Minas Constantinides, MD, Richard E. Davis, MD, and Sam P. Most, MD. The objective of the workgroup was to propose quality measures for patients undergoing rhinoplasty. This measure set was developed within the framework of the 2018 clinical practice guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation entitled ‘‘Clinical Practice Guideline: Improving Nasal Form and Function After Rhinoplasty.’’ Using a rigorous protocol, the workgroup identified 1 outcome measure and 3 process measures. The workgroup focused on common aspects of the majority of rhinoplasties being performed. The outcome measure focused on patient satisfaction as determined by completion of a validated patient satisfaction tool. The process measures focused on shared decision making for postoperative pain management, presurgical discussion of motivations and outcomes for patients undergoing rhinoplasty, and airway assessment for patients undergoing rhinoplasty. Overall, these rhinoplasty measures are intended to serve as drivers of performance improvement and not to be used punitively. The workgroup intended for the measures to be utilized by health care professionals who are board certified or board eligible to perform aesthetic and functional rhinoplasties. Ideally, these performance measures will promote quality improvement at the individual and system levels. They should also facilitate continuing medical education, continuing certification, and compliance with required quality reporting programs. For example, the technical specifications for the measures were drafted to account for surgeons from a variety of practice types. The measures are designed with adaptability for registry specifications for those not using an electronic health record (EHR) and with specifications for those using an EHR. Participation in a qualified clinical data registry, such as the AAO-HNS’s Regent, is possible by using these measures with reporting through an EHR or independent of an EHR. In a value-based health care environment, this rhinoplasty performance measure set can be viewed as the start of iterative improvement processes, ultimately with patient outcomes and safety at the center of our motivations.