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The Development of Quality of Care Measures for Oral Cavity Cancer

The Development of Quality of Care Measures for Oral Cavity Cancer In 2005 under the leadership of then-President Randal S. Weber, MD, the American Head and Neck Society formed an ad hoc committee on quality of care whose charge was to develop evidence-based quality of care measures for patients with head and neck neoplasia. Developing these guidelines was viewed as imperative to providing the highest quality of care for our patients and to ensure that the American Head and Neck Society provides leadership in defining appropriate standards of care in an era of value-based purchasing. Amy Y. Chen, MD, MPH, and Dr Weber are co-chairs of the committee. Steps for developing these quality of care measures included: Identifying a neoplastic disease of high prevalence in the head and neck surgery practice. Identifying common measurable treatment practices during the preoperative, course of treatment, and posttreatment periods. Performing literature reviews to identify evidence for the measures from step 2. Proposing measures by which practitioners can evaluate their treatment practices A multidisciplinary committee was formed and began work in the summer of 2006 by vetting disease sites for our foray into developing quality of care measures. After much discussion, the committee decided to focus on oral cavity cancer as an initial undertaking. The group then divided into 3 working groups concentrating on pretreatment, treatment, and posttreatment measures. An exhaustive literature search for high levels of evidence was performed, and then quality of care measures were developed from this search. The committee discussed the different measures that emerged from this stage of the process and agreed on 2 to 3 measures for pretreatment, treatment, and posttreatment care. The quality of care measures were developed by consensus, appropriately referenced, and submitted to the Executive Council of the American Head and Neck Society, which approved them in December 2007. The pretreatment evaluation quality of care parameters selected are as follows: All oral tongue cancer patients require documentation of pathology using College of American Pathologists criteria with histopathologic confirmation of disease. All oral tongue cancer patients require documentation of the appropriate TNM staging (as defined by the American Joint Committee on Cancer). Assessment of primary tumor size (T); Assessment of regional nodal basins for metastatic lymphadenopathy (N); Assessment for systemic disease (M); this should include documentation of a complete head and neck examination, appropriate radiologic imaging of the head and neck, and chest x-ray. Tobacco cessation counseling. The treatment-related quality of care measures state the following: All oral cavity cancer patients with advanced T stage or metastatic lymph nodes should be referred to radiation oncology for consideration of postoperative radiotherapy. All oral cavity cancer patients with positive pathologic margins or metastatic lymph nodes showing extracapsular extension should be referred to a medical oncologist and radiation oncologist for consideration for adjuvant chemotherapy and radiation. The quality of care measures for posttreatment surveillance are as follows: All patients treated for oral cavity cancer should have follow-up visits for symptom management and surveillance for recurrence and second primary tumors. Patients treated with radiation therapy to the neck should have assessment of serum thyroid stimulating hormone level to detect hypothyroidism. Posttreatment serum thyroid stimulating hormone levels should be checked within 12 months of completing radiotherapy. With this communication, the committee on quality of care is soliciting comments from the American Head and Neck Society membership. Please reply to quality@ahns.infowith comments and questions. The committee plans to “launch” the quality of care measures at the Seventh International Conference on Head and Neck Cancer (San Francisco, California) in July 2008. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

The Development of Quality of Care Measures for Oral Cavity Cancer

Archives of Otolaryngology - Head & Neck Surgery , Volume 134 (6) – Jun 1, 2008

The Development of Quality of Care Measures for Oral Cavity Cancer

Abstract

In 2005 under the leadership of then-President Randal S. Weber, MD, the American Head and Neck Society formed an ad hoc committee on quality of care whose charge was to develop evidence-based quality of care measures for patients with head and neck neoplasia. Developing these guidelines was viewed as imperative to providing the highest quality of care for our patients and to ensure that the American Head and Neck Society provides leadership in defining appropriate standards of care in an era...
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Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.134.6.672
Publisher site
See Article on Publisher Site

Abstract

In 2005 under the leadership of then-President Randal S. Weber, MD, the American Head and Neck Society formed an ad hoc committee on quality of care whose charge was to develop evidence-based quality of care measures for patients with head and neck neoplasia. Developing these guidelines was viewed as imperative to providing the highest quality of care for our patients and to ensure that the American Head and Neck Society provides leadership in defining appropriate standards of care in an era of value-based purchasing. Amy Y. Chen, MD, MPH, and Dr Weber are co-chairs of the committee. Steps for developing these quality of care measures included: Identifying a neoplastic disease of high prevalence in the head and neck surgery practice. Identifying common measurable treatment practices during the preoperative, course of treatment, and posttreatment periods. Performing literature reviews to identify evidence for the measures from step 2. Proposing measures by which practitioners can evaluate their treatment practices A multidisciplinary committee was formed and began work in the summer of 2006 by vetting disease sites for our foray into developing quality of care measures. After much discussion, the committee decided to focus on oral cavity cancer as an initial undertaking. The group then divided into 3 working groups concentrating on pretreatment, treatment, and posttreatment measures. An exhaustive literature search for high levels of evidence was performed, and then quality of care measures were developed from this search. The committee discussed the different measures that emerged from this stage of the process and agreed on 2 to 3 measures for pretreatment, treatment, and posttreatment care. The quality of care measures were developed by consensus, appropriately referenced, and submitted to the Executive Council of the American Head and Neck Society, which approved them in December 2007. The pretreatment evaluation quality of care parameters selected are as follows: All oral tongue cancer patients require documentation of pathology using College of American Pathologists criteria with histopathologic confirmation of disease. All oral tongue cancer patients require documentation of the appropriate TNM staging (as defined by the American Joint Committee on Cancer). Assessment of primary tumor size (T); Assessment of regional nodal basins for metastatic lymphadenopathy (N); Assessment for systemic disease (M); this should include documentation of a complete head and neck examination, appropriate radiologic imaging of the head and neck, and chest x-ray. Tobacco cessation counseling. The treatment-related quality of care measures state the following: All oral cavity cancer patients with advanced T stage or metastatic lymph nodes should be referred to radiation oncology for consideration of postoperative radiotherapy. All oral cavity cancer patients with positive pathologic margins or metastatic lymph nodes showing extracapsular extension should be referred to a medical oncologist and radiation oncologist for consideration for adjuvant chemotherapy and radiation. The quality of care measures for posttreatment surveillance are as follows: All patients treated for oral cavity cancer should have follow-up visits for symptom management and surveillance for recurrence and second primary tumors. Patients treated with radiation therapy to the neck should have assessment of serum thyroid stimulating hormone level to detect hypothyroidism. Posttreatment serum thyroid stimulating hormone levels should be checked within 12 months of completing radiotherapy. With this communication, the committee on quality of care is soliciting comments from the American Head and Neck Society membership. Please reply to quality@ahns.infowith comments and questions. The committee plans to “launch” the quality of care measures at the Seventh International Conference on Head and Neck Cancer (San Francisco, California) in July 2008.

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Jun 1, 2008

Keywords: quality of care,oral cancer

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