Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry‐Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

Abstract

Background and Significance Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. Methods We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. Results The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. Conclusion Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.

Trends in Response Rate to US News & World Report Best Hospitals Reputation Survey, 2015 to 2023

“…USNWR must collaborate with specialists to incorporate specialty-specific measures that are meaningful to both patients and providers. In recent years, otolaryngologists have worked to develop specialty-specific quality measures through efforts led by the American Academy of Otolaryngology-Head and Neck Surgery, [14][15][16] subspecialty societies, [17][18][19][20] and independent investigators. 21,22 To (A) (B) enhance the validity of otolaryngology rankings, USNWR should consider incorporating such measures (e.g., time to adjuvant radiation after head and neck cancer surgery 20 ).…”

Corticosteroid Use in Otolaryngology: Current Considerations During the COVID‐19 Era

“…Promoting evidence‐based use of corticosteroids is part of a broader effort to improve otolaryngologic care, as exemplified by the AAO‐HNS’s clinical data registry, RegENT 194,195 . Clinicians should embrace evidence‐based strategies, incorporating patient preferences, 196 engaging patients in shared decision making, 197 striving to reduce adverse events, 198 and enhancing safety and quality 199,200 .…”

“…192,193 Promoting evidence-based use of corticosteroids is part of a broader effort to improve otolaryngologic care, as exemplified by the AAO-HNS's clinical data registry, RegENT. 194,195 Clinicians should embrace evidence-based strategies, incorporating patient preferences, 196 engaging patients in shared decision making, 197 striving to reduce adverse events, 198 and enhancing safety and quality. 199,200 Decisions regarding SCS must also be tailored to a patient's individual history and to risk factors that may influence its use-whether in terms of modifying conditions (eg, history of ulcer, diabetes, hypertension, osteoporosis, cardiopulmonary disorders, epilepsy, or psychiatric illness) or medications (eg, immunosuppressants, nonsteroidal anti-inflammatory drugs, antimicrobials, diuretics, anticoagulants, antihypertensives, antiepileptics).…”