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). 

Objectives

1. Benchmarking
2. Quality measurement
3. Quality improvement
4. Clinical effectiveness
5. 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.

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:

1. The audit questionnaires for clarity, length, user-friendliness, relevance
2. The following processes: registration, access, data entry…
3. The sustainability of project if it was to be run as consented audit and if it kept relying on clinicians for data entry.

QOMS Phase 2 – Project description

Ahead of the publication of the first GIRFT report, which highlighted the absence of a comprehensive set of clinical outcome measures for OMFS, BAOMS set up the Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS). QOMS is the quality improvement and clinical effectiveness programme for OMFS.

To meet the needs of the specialty, QOMS developed a series of audits to address issues around quality of care and improvement, and several registries are being developed for 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).  

Following an initial pilot process (December 2019 - March 2020) in 6 OMFS units in England, QOMS underwent some refinements. The new phase of QOMS will be open to every OMFS unit and surgeon in the UK (pending information governance) and will effectively be the initiation of the definitive QOMS data collection process. Funding support will be made available from BAOMS and Saving Faces, for 10 OMFS units to employ a dedicated data co-ordinator to effectively support high-quality and comprehensive data collection.

• The selection of the participating OMFS units will be based on their track record in engagement with quality improvement, national audit and academic outcomes. The process will require committed engagement from all local OMF surgeons and the hospitals’ medical directors. 
• The position of data co-ordinator will be part-time (2 sessions a week) and supported by a  grant. The individual selected will work closely with the local QOMS clinical lead and other surgeons to collect and update data for the project.  

The application form and a job description to help hospitals recruit their data co-ordinator have been prepared and approved by BAOMS Council. They are available here:

• OMFS Unit funding application form
• Job description for data-co-ordinator (not yet available)

Timeline:

• Application must be returned by 22 January 2021 to Sarah Durham. Late applications will not be considered.
• A webinar to engage with BAOMS membership has been planned for 13 November 2020 at 17:30 hrs
• Decision will be made by the BAOMS QOMS Team and Representatives of the BAOMS Council and Saving Faces, confirmation of outcome by 18 January 2021.
• OMFS Units allocated funding will then need to employ a part-time data co-ordinator for the local BAOMS QOMS initiative.
• Expected starting date for data collection: February / March 2021