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Measuring the Quality of Care at the Cedars-Sinai Sinus Center
To continually improve the care given to patients at the Cedars-Sinai Sinus Center, a number of factors that lead to a high quality of care are monitored. These include:
- The volume of procedures done: Studies suggest that for many surgical procedures, hospitals that perform high volumes have better quality outcomes, i.e. lower short-term and long term mortality and morbidity. Volume is an indicator of experience, which influences outcomes in multiple ways. In addition to the experience of surgeons in performing specific procedures, high volume hospitals may institute specific care processes that improve outcomes and have the infrastructure dedicated to particular clinical specialties, including related technology and intensive care personnel. Commitment to quality standards throughout the institution is also an important determinant of better outcomes.1,2 In addition, outcomes for high-risk procedures have been shown to be better when performed by more highly-trained surgeons than by general surgeons.3
- The percentage of procedures done on an outpatient basis. Procedures done on an outpatient basis tend to be minimally invasive. Outpatient procedures are usually easier to recover from and present less disruption to a patient's daily activities.
- Training leads to improved skills thus improved outcomes. The Sinus Center participates in advanced courses in sinus surgery.
- Education for physicians. Members are required to participate in educational forums.
- All patients undergo quality assurance evaluations to assure high quality care.
The chart below shows the volumes of all sinus surgeries performed by Centers of Excellence physicians.
Sinus procedures are defined as ICD-9 procedure codes: 21.5, 21.88, 22.2, 22.31, 22.41, 22.42, 22.51 - 22.53, 22.6, 22.62-22.64, 22.79, and 22.9.
The Sino-Nasal Outcome Test (SNOT-22) is a tool that asks patients at three months, six months and 12 months after surgery to rate the severity of their symptoms, physical problems, functional limitations and the emotional impact they experience. It asks such questions as how much of a problem are sneezing, blockages in the nose, ear fullness, loss of smell or taste, facial pain or pressure, difficulty sleeping or emotional impacts such as embarrassment, frustration or irritability.
It has been deemed reliable with three aspects of validity and widely accepted as a measure of efficacy for both medical and surgical therapy. Efficacy evaluations have been found to be statistically significant at three, six and 12 months post treatment. It is easy for the patients to respond to and usually takes five to 10 minutes to complete.
The chart below shows the percent improvement of symptoms for patients after balloon sinuplasty at three, six and 12 months after treatment. The data is based on patients surveyed April 2009 thru April 2014.
|SNOT-SUMMARY||3 month||6 month||12 month|
|# of patients with Pre & Follow-up Score||236||166||111|
|# of patients with improvement in score||198||143||97|
|# of patients with a worsening in score||32||20||12|
|# of patients with same score||6||3||2|
1Bach PB, Ann Intern Med 2009; 150:729-30
2Greene FL, Ann Surg Oncol 2007; 15:14-15
3Kozower BD et al, Ann Thorac Surg 2008; 86:1405-08