Improving practice and patient care in OMFS

This page is aimed at OMF surgeons and other health care professionals interested in the QOMS project.  A similar page for patients and members of the public interested is available here.

• March 2021 issue
• October 2020 issue

TABLE OF CONTENTS

2020 and 2021 have so far been quite interesting and challenging and we hope that the rest of 2021 will see a return to "normal". 

Over this period, BAOMS has run 3 COVID-19 service evaluations (dental infection and OMFS trauma), the results of which have been published online in BJOMS and collaborated in the COVIDTrach project, which has now published 2 reports.  (See Publications).

The QOMS project team has been working on the next phase of the QOMS project. There are still opportunities for surgeons to have direct inputs into QOMS, simply contact the Project Manager Fabien Puglia or via the QOMS forum.

WHAT IS QOMS?

Escalating healthcare expenditure in the NHS is unsustainable, and service commissioners need to provide cost-effective surgical procedures that demonstrate clear health benefits in line with best evidence-based practice. 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 in publication of clinical outcomes across the UK (McMahon et al. 2018, Ho et al. 2021).

In November 2018, the Getting It Right First Time (GIRFT) initiative published their first report for the oral and maxillofacial surgery. The report highlighted the lack of systematic clinical outcome measures in place, thus limiting opportunities for the specialty:

• To understand if care was being delivered in line with standards
• For providers to benchmark themselves against others
• To support continuous improvement.

Recommendation 5 of the GIRFT recommendations was to "Deliver an efficient and patient-focused outcomes audit programme for oral and maxillofacial surgery”.

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 OMFS and ensuring effectiveness of care provided based upon appropriate metrics were key to the continued successful development of surgical care in the NHS and reflected the core culture of the Association.

QOMS is the quality improvement and clinical effectiveness programme for OMFS.

To meet the needs of the specialty, QOMS developed a series of registries to address issues around quality of care and improvement, and clinical effectiveness. The Subspecialty Interest Groups and the membership were consulted to decide on the procedures, conditions and the quality-of-care indicators to be included in QOMS.

Data collection and storage is managed by the Barts Cancer Research-UK Centre at Queen Mary University of London (BCC, QMUL), using the Research Electronic Data Capture software (REDCap). 

• Watch our introductory videos 
• Meet the team section (under construction)

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QOMS AIMS

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 core OMFS activities.

QOMS basically is composed of a series of clinical registries set up to collect data about OMFS practices in the UK and in time the Republic of Ireland. They were developed for either quality improvement (audits or service evaluations) or clinical effectiveness and surveillance (disease- and procedure-specific registries). QOMS exists in parallel to other already existing registries and quality improvement initiatives (see below).

Figure 1. Roles of clinical registries

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QOMS AUDIT ACTIVITIES

Data collected in QOMS will be used to compare OMFS units across the UK and identify and share best care practices. The project focuses on areas of the care process that impact on OMFS surgical teams.

Figure 2. Use of clinical registries for audit and quality improvement activities

QOMS wants 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.

Figure 3 - Oral & dentoalveolar

Figure 4 - Trauma

Figure 5 - Oncology

Figure 6 – Reconstruction

Figure 7 - Non-melanoma skin cancers

Figure 8 – Orthognathic​​​​​​​

The orthognathic component of QOMS is also interested in collecting patient reported outcome and experience measures (PROM / PREM) and is working with the British Orthodontic Society (BOS) to select and develop this tool. 

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QOMS REGISTRY ACTIVITIES

While audit activities mainly concentrate on the lower part of the clinical registry cycle, QOMS aims to also develop in time some disease- or procedure-specific registries. Those registries will be used to assess the long-term effects and the changes of current practices on care quality and patient’s outcomes and look at OMFS practice for which there is little or no strong available evidence and support the development of for high-quality, strong recommendations.

 Figure 9. Use of clinical registries for clinical effectiveness, disease- and procedure-specific registries

With the launch of the 2^nd phase of QOMS in spring 2021, the project team will focus their attention towards developing those registries. At the onset of QOMS, the following themes were proposed:

• Salivary gland cancer
• Patient-specific mandibular implants
• Benign tumours of the jaws

In a first instance, the team will focus on writing up the protocols for those registries to highlight their aims and how they will be run.

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OTHER NATIONAL REGISTRIES AND QUALITY IMPROVEMENT INITIATIVES

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QOMS STRUCTURE AND ORGANISATION

QOMS is overseen by the BAOMS Council and the QOMS Steering Committee. The QOMS team is led by the BAOMS QOMS Clinical Lead, Mr Michael Ho, and deputy lead, Mr David Tighe. The QOMS Project manager, Dr Fabien Puglia, is responsible for the day-to-day activities of the project.

The project team also include:

• The Information Governance Group (IGG), which deals with all information governance issues. The IGG includes Mr Michael Ho, Mr Jeremy McMahon (Caldicott Guardian), Dr Marisa Mason (National Confidential Enquiry into Patient Outcome and Death NCEPOD) and Dr Fabien Puglia.
• The Audit and Registry working groups:
  • Oncology-Reconstruction and Skin cancer: Mr Panayiotis Kyzas and Mr Conor Bowe
  • Trauma and Oral and dentoalveolar surgery: Mr Geoff Chiu and Mr Basim Dawoud
  • Orthognathic surgery: Professor Ashraf Ayoub, Mr Moorthy Halsnad, Ms Christine Lwin, and Mr Alexander Hills
  • Salivary gland cancers: Mr Damian Broderick
• Trainee representative: Ms Harmony Ubhi
• A Patient and Public Involvement group made up by patients and lay members to represent the opinions and voices of patients from different subspecialties.    
• QOMS is also supported by members of Saving Faces: Professor Iain Hutchison and Dr Fran Ridout.

Meet the team section (under construction)

Figure 10. Structure of the QOMS project

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QOMS PILOT 2021

Following the initial audit pilot (December 2019 - March 2020) in 6 OMFS units in England and the feedback we received, QOMS underwent further refinement (for more details, read Ho et al. (2021) BJOMS).

• Questionnaires have been revised by the new Audit Groups and SSIGs to improve their content, structure and flow.
• To ease the burden of the data collection process, where it was possible, we are seeking support to collect patient data without consent. QOMS has been granted support for Confidentiality Advisory Group (CAG) section 251 in England and Wales. We are preparing a similar application to the Public Benefit and Privacy Panel for Health and Social Care (PBPP) in Scotland. However, as it stands, data collection will be anonymous in the Scotland and Northern Ireland. There is no equivalent regulatory body in Northern Ireland (and the Republic of Ireland).
• Appointment of Data Coordinators in OMFS units to support and improve data collection. This is a 3-year pilot to demonstrate the value of encouraging NHS Trusts and Health Boards to support this process in the long term (see below for more details).   

The new phase of QOMS will be open to every OMFS unit and/or surgeon in the UK (subject to local information governance approval) and will effectively be the initiation of the definitive QOMS data collection process. Some funding from BAOMS is being provided to 10 OMFS units to employ a dedicated data co-ordinator to effectively support high-quality and comprehensive data collection.

Application for this funding opened to every OMFS units nationwide at the end of 2020. Unit selection was based on a competitive process: track record in engagement with quality improvement, national audit and academic outcomes. Successful applications required the committed engagement from all local OMF surgeons and the hospitals’ medical directors.

The data co-ordinator job is a part-time position and its funding supported by a pump-priming grant for 3 years. The individual appointed will work closely with the local QOMS clinical lead and other surgeons to collect and update data for the project. Behind that 3-year initial funding, BAOMS hopes:

• To have demonstrated the importance and value of the QOMS programme and
• That OMFS departments will be able to secure local funding from their NHS Trusts and Health Boards to continue data collection or to start taking part inQOMS.  

For interested units, the data co-ordinator job description is available here  (if not logged in already, you will need to login to the Members' area first to view this document, under Members>Further Resources>QOMS documents).

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WHICH UNITS ARE TAKING PART IN QOMS?

QOMS is open to every unit in the UK.  The following units are already taking part:

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OTHER MEDIA

• QOMS short protocol (if not logged in already, you will need to login to the Members' area first to view this document, under Members>Further Resources>QOMS documents).
• How to register to REDCap
• QOMS REDCap user registration form 
• How to use REDCap
• Data collection tools 

Important links:

• QOMS LIVE REDCap database - where real data is entered
• QOMS TEST REDCap database - to explore the system
• Forgotten password? Visit the BCC Password Selfservice.
• For any other problem, contact Fabien Puglia

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Tweets by BAOMS_QOMS

Last updated: April 2021