QOMS - Quality Outcomes in Oral & Maxillofacial Surgery
Improving practice and patient care in OMFS
In these unprecedented times we do not want to forget that the whole future of our specialty will depend on getting the QOMS project right. While there are several initiatives looking at how the COVID crisis is affecting patient care (including 3 BAOMS key service evaluations, the project team is now working to develop the next phase of the QOMS project.
After the crisis phase of COVID passes, we want to be in a position to move the project forward.
We still invite other Trusts who have staff who can link to their hospital from home to explore the portals and feedback their experience to Fabien Puglia, Project Manager, or via the QOMS forum.
There are still opportunities for surgeons to have direct inputs in QOMS.
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.
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.
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 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 evaluation) 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).
- Quality measurement
- Quality improvement
- Clinical effectiveness
- 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.
QOMS Pilot Summary
The leads and deputy leads of the participating SSIGs and the Project Team have developed 6 questionnaires to collect data for the following subspecialties: oral and dentoalveolar, oncology and reconstruction and orthognathic, skin and trauma.
QOMS is collecting data using the Research Electronic Data Capture system (REDCap) developed by the Vanderbilt University, Nashville, TN. For our project, REDCap is hosted and administered by the Barts Cancer Centre (BCC), Queen Mary University of London (QMUL).
The QOMS Pilot ran from December 2019 to April 2020 in 6 Hospitals in England (it officially stopped on May 1st 2020). It aims were to test with real-world data:
- The audit questionnaires for clarity, length, user-friendliness, relevance
- The following processes: registration, access, data entry…
- The sustainability of project if it was to be run as consented audit and if it kept relying on clinicians for data entry.
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.
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.
Oral & dentoalveolar
QOMS registry activities (to follow)
QOMS specific registries will be used;
- To assess the long-term effects and the changes of current practices on care quality and patient’s outcomes and
- To look at OMFS practice for which there is little or no strong available evidence to support for high-quality strong recommendations.
While QOMS audit activities mainly concentrate on the lower part of the clinical registry cycle below, QOMS aims to also develop in time some disease- or procedure-specific registries (Salivary gland cancer and patient-specific mandibular implants, respectively have already been proposed). These registries will be focusing on outcomes and clinical effectiveness.
The TMJ replacement registry already exists and is administered independently of QOMS. We hope that its inclusion in QOMS (its data will form part of the QOMS annual report) will help promote its use amongst TMJ surgeons.
Other national registries
The QOMS project team is also working with the Saving-Faces-run Head And Neck Audit (HANA) to minimise data entry across the subspecialties of oncology and reconstruction and the BAPRAS-run UK National Flap Registry (UKNFR), which published its first report in 2019.
In parallel, efforts are underway for data coded and collected through the hospital episodes and statistics (HES) system to be utilised for comparative purposes, hence accurate numbers and good quality data will be essential in providing information for the next phase of the BAOMS QOMS initiative.
If you have any questions or thoughts you’d like to share with us, please contact: Fabien Puglia, QOMS Project Manager