Quality and Outcomes in oral and Maxillofacial Surgery (QOMS): improving practice and patient care in OMFS
Background: The British Association of Oral and Maxillofacial Surgeons (BAOMS), under its 2018 President Mr Ian Martin and with the support of Council, initiated a specialty-wide quality improvement and clinical effectiveness programme, the Quality and Outcomes in oral and Maxillofacial Surgery (QOMS). This reflected the President’s view that implementing systematic quality improvement in Oral and Maxillofacial Surgery (OMFS), and ensuring effectiveness of care provided based upon appropriate metrics is key to the continued successful development of surgical care in the NHS and reflects the core culture of the Association.
Aim: To set up and develop a sustainable quality management and clinical effectiveness programme that delivers continuous improvement in the care of patients undergoing OMFS within all parts of the NHS and demonstrates health-related benefits to patients from selected OMFS activities.
- Benchmarking: Benchmarking is the process of establishing a standard and comparing an activity with that standard. Benchmarking is a continuous process, which requires quantitative measurement of the subject, and a component of quality management. It is used to compare performance within a healthcare setting. The average performance on any given quality metric across participating institutions may also be compared to published benchmarking data from other healthcare systems.
- Quality measurement: To put in place a system to measure quality of care in OMFS whereby participating departments submit data to a central unit that calculates and risk-adjusts selected quality metrics. Each department is then able to compare their performance against the average performance across all participating departments or available standards and benchmarks.
- Quality improvement: To identify OMFS departments as having outlier performance against any metric. In the case of positive outliers, to organise site visit(s) and document the care practices that underpin their results in order to disseminate that knowledge across the specialty. In the case of underperforming departments, after confirming the presence of problem, the project team with the local clinical effectiveness team will assist them through site visit(s) to identify problems and by arranging a mentoring system to enable change.
- Clinical effectiveness: To create a platform to collect appropriate data to develop practice-based evidence of clinical effectiveness. The specialty is engaged in the management of a number of rare conditions, including a range of craniofacial syndromic conditions requiring surgery and some neoplastic diseases, such as odontogenic tumours and salivary gland malignancies, for which randomised-controlled trials are not feasible. Optimal management practices are likely to emerge by compiling that information in a registry that can then be used by clinicians and where appropriate by commissioners and policy-makers, for example in their deliberations on sustained funding.
- Continuous personal and career development: To promote clinicians’ participation in the registry, support their appraisal and revalidation processes; to develop and nurture QI skills and culture throughout the specialty and to see a coalescence of outcomes around the very best performers across all quality metrics.
Current Status: After a consultation period with the BAOMS membership, with input from patient representatives, and with mentorship from NCEPOD it was decided QOMS plans to identify best performers against any given metric across the NHS, quality assure that data, and then generalise the care practices that underpin it by case studies, newsletters, presentations at conference, as well as BAOMS website content. Where performance falls significantly below the mean, and data checking confirms that to be the case, the Association intends to provide mentorship for change.
QOMS is about to start a 3 month pilot phase in six hospitals across NHS England prior to a national roll-out in 2020.
Escalating healthcare expenditure in the NHS is unsustainable, and service commissioners need to provide surgical procedures that demonstrate clear health benefits, best practice and cost-effectiveness. Patients should expect, and demand, high quality care and the best possible surgical outcomes from oral and maxillofacial surgery (OMFS), but the specialty lags behind other surgical specialties. To address the issue, 2018 British Association of Oral and Maxillofacial Surgeons (BAOMS) President, Ian Martin, initiated a specialty-wide quality improvement (QI) and clinical effectiveness initiative: the Quality and Outcomes in oral and Maxillofacial Surgery (QOMS) project.
To set up and develop a sustainable quality management and clinical effectiveness programme that delivers continuous improvement in the care of patients undergoing OMFS within all parts of the NHS and demonstrates health-related benefits to patients from selected OMFS activities. More broadly, QOMS will try to generate research hypotheses that could lead to progress and changes in OMFS practices.
Finally, QOMS will try to develop and nurture QI skills and culture throughout the specialty and to see a coalescence of outcomes around the very best performers across all quality metrics by promoting clinicians’ participation in QOMS and supporting them in their appraisal and revalidation process.
What forms will QOMS take?
Following the consultation with BAOMS membership and the SSIG leads and deputy leads, it was decided that QOMS would run a series of audits across several OMFS subspecialties as well as develop registries looking at OMFS practices for which there is little or no strong available evidence to support for high-quality strong recommendations.
As part of its audit activities, the information collected by QOMS will be used to compare OMFS units across the UK and identify and share best care practices. The project will focus specifically on the areas of the care process that impact on OMFS surgical teams.
For the registries, QOMS will be used to assess the long-term effects and the changes of current practices on care quality and patient’s outcomes.
Where are we at?
For more details see the QOMS Newsletter.
The list of procedures and metrics for QOMS has been agreed on and can be found below (the information is also available in document format for your ease if there are any mobile device issues with legibility).
List of procedures and metrics included in QOMS by subspecialty:
Oral and dentoalveolar
The following registries will be established:
- We have developed an extensive protocol describing the principles behind the project and the analytical and reporting strategies the project intent to implement. Download the short version of the protocol.
- An IT solution was chosen.
QOMS will collect data using the Research Data Capture system (REDCap) developed by the Vanderbilt University, Nashville, TN. For our project, REDCap will be hosted and administered by the Bart’s Cancer Centre (BCC) at Queen Mary University of London (QMUL).
- Build the electronic tools to collect data by the Summer of 2019
- Run a 3-month consented pilot from August 2019
- Sort out the Project’s information governance
- Roll out QOMS nationally in early 2020
Let us know if you and your OMFS department would be interested in taking part in the pilot.
If you have any questions or thoughts you’d like to share with us, please contact: Fabien Puglia, QOMS Project Manager
Click this link to find the list of OPCS codes for the specialty
Keep watching this space!