American Academy of Otolaryngology-Head and Neck Surgery
Statement of Position on Performance Measures
August 31, 2006
Statement of Principles
The American Academy of Otolaryngology-Head and Neck Surgery is committed to advancing the practice of high quality, cost-effective health care for otolaryngology and head and neck surgery patients. The Academy supports health care quality improvement endeavors, including the development and application of performance measures that are:
- Aimed at improving patient care, health status, outcomes, and satisfaction;
- Consistent with the informed patient’s values and preferences;
- Consistent with current evidence and professional knowledge of safe, appropriate and effective care; and
- Feasible given the information and resources available across practice settings;
The spirit in which performance measures are developed and applied should be one of continuous improvement, and the primary purpose of performance measurement should be to identify opportunities to improve patient care. The AAO-HNS encourages the utilization of performance measures that are consistent with the criteria described below for evaluating and improving patient care.
Performance measurement is the quantitative assessment of health care processes and outcomes for which an individual physician or other practitioner, health care organization, or health care system may be accountable. A performance measure, or indicator, is a quantitative expression that describes whether, or how often, a process of care or outcome of care occurs.
Attributes of performance measures are characteristics that define appropriate and useful measures. The following criteria shall be used by the AAO-HNS to evaluate the attributes of performance measures for adoption and endorsement by the Academy. These attributes are consistent with those required by the AMA’s Physician Consortium on Performance Improvement, of which the AAO-HNS is a member. By adopting these criteria, the Academy is promoting consistency in performance measurement and supporting further collaboration among physician specialty societies.
Importance of Dimension of Care Measured
- Evidence-based. The aim of the measure should be to improve patient outcomes. The measure should be evidence-based whenever possible. For process measures, there should be good evidence that the process improves health outcomes. For outcomes measures, there should be good evidence that there are processes or actions that providers can take to improve the outcome. When scientific evidence does not exist, the measure should reflect a high degree of professional agreement, including agreement by across appropriate specialty groups.
- Substantial potential for improvement. A significant gap should exist between optimal and current clinical practice. The gap should be amenable to substantial improvement by means of feasible intervention.
- Severity and prevalence. The condition and its prevalence in the population should be significant enough to justify targeting the condition for improvement.
- Substantial impact. The measure should hold the potential for substantial impact on the health status, health outcomes, and satisfaction of individual patients and be capable of improving the health status of a community or population of patients. The measure should be relevant to physicians and their patients and should be amenable to evaluation.
- Improve value. Measures should have the potential to improve value of health services for patients, plans, and purchasers of health care.
- Accurate and reliable. The measure is able to identify the events it was designed to identify and is consistently reproducible across health care organizations and delivery settings.
- Valid. The measure is scientifically valid as demonstrated by rigorous external testing. There is face-validity, indicating obvious appropriateness or agreement by experts; construct validity, indicating that the measure correlates well with similar measures; and content validity, indicating a comprehensive picture of the care being provided.
- Precisely defined and specified. The measure specifications should include:
- The rationale or intent of the measure;
- A description of the performance measure population (numerator, denominator, exclusions from the denominator);
- Defined sampling procedures, when applicable;
- Defined data elements and data sources; and,
- Instructions for collecting and reporting data for the measure.
- Easily interpreted. The measure can be interpreted by those using the information.
- Risk adjusted. If the measure is intended for meaningful comparison with the performance of others, it should be risk adjusted. Risk adjustment requires that the characteristics that impact health outcomes among different populations, including those beyond a health system’s control, should be known and measured. There should be valid models for adjusting results to correct for the effects of those characteristics.
- Improvement attainable. The health outcome goal of the measure can be achieved, or an improvement can be accomplished, in the settings in which it is applied.
- Reasonable cost. The measure should not impose an inappropriate financial burden on those collecting the data. The cost of collecting the data should be justified by the improvements made.
- Feasible. The measure should be feasible for a physician to implement. For example,
- Data for the measures are readily available;
- Patient confidentiality is maintained;
- The number of required measures is reasonable;
- Realistic time frames are expected to collect data;
- Instructive materials accompany performance measures; and
- To the extent possible, measures and specifications should remain consistent over a period of time long enough to complete a cycle of improvement.
- Adaptable. The measure is readily adaptable across various specialties and practice settings (e.g., solo practice, large group practice).
Important Disclaimer Notice
Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery, Inc. or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements as guidance for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.