Datema Frank R, van Zijl Floris V W J, van der Poel Egge F, Baatenburg de Jong Robert J, Lohuis Peter J F M
Rotterdam and Zeist, The Netherlands.
From the Department of Otolaryngology/Head and Neck Surgery, Erasmus Medical Center, Rotterdam; and the Department of Otolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital Utrecht.
Plast Reconstr Surg. 2017 Oct;140(4):691-702. doi: 10.1097/PRS.0000000000003701.
Patients, governments, health care providers, and insurance companies are increasingly interested in medical performance. Transparent outcome reporting requires a thorough methodologic design, dedicated prospective data collection process, and preferably no interference with the efficacy of daily practice. The primary aim of this article is to describe how these bottlenecks are tackled with an automated prospective rhinoplasty outcome routine. The secondary aim is to motivate others by describing practical benefits encountered during implementation.
Since April 2014, 269 consecutive patients referred for functional-aesthetic (revision) rhinoplasty were included. The Nasal Obstruction Symptom Evaluation scale, the Utrecht Questionnaire, and visual analogue scales were offered to all patients before primary consultation and follow-up to translate the subjective burden of nasal problems and change herein following surgery, into data. These data were exported for real-time automated outcome analysis supported by graphic output through a customized Web-based dashboard.
One hundred seventy-one patients proved eligible for rhinoplasty, of which 121 had sufficient follow-up. The dashboard provides an overview of demographic characteristics of different populations, reasons why rhinoplasties were not performed, and real-time short- and long-term change in functional and aesthetic outcome in both primary and revision cases. Practical benefits of the instruments used are presented and discussed.
Routine prospective outcome monitoring provides an evidence-based response to the increasing demand for transparency in health care. The dashboard proved valuable during patient counseling, patient selection, and management of expectations and has the potential to compare rhinoplasty results between surgeons and institutions, provided that the populations share similar characteristics.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
患者、政府、医疗服务提供者和保险公司对医疗绩效的兴趣日益浓厚。透明的结果报告需要完善的方法学设计、专门的前瞻性数据收集过程，并且最好不干扰日常医疗实践的疗效。本文的主要目的是描述如何通过自动化的前瞻性鼻整形手术结果程序来解决这些瓶颈问题。次要目的是通过描述实施过程中遇到的实际益处来激励他人。
自2014年4月起，纳入了269例连续接受功能性-美学（修复）鼻整形手术的患者。在初次咨询和随访前，向所有患者提供鼻阻塞症状评估量表、乌得勒支问卷和视觉模拟量表，以将鼻腔问题的主观负担及其术后变化转化为数据。这些数据通过定制的基于网络的仪表板导出，以进行实时自动化结果分析，并提供图形输出支持。
171例患者被证明符合鼻整形手术条件，其中121例有足够的随访。该仪表板提供了不同人群的人口统计学特征概述、未进行鼻整形手术的原因，以及初次手术和修复手术病例中功能和美学结果的实时短期和长期变化。展示并讨论了所使用工具的实际益处。
常规前瞻性结果监测为医疗保健领域对透明度日益增长的需求提供了基于证据的回应。该仪表板在患者咨询、患者选择和期望管理过程中被证明是有价值的，并且有潜力在外科医生和机构之间比较鼻整形手术结果，前提是人群具有相似特征。
临床问题/证据水平：治疗性，IV级。
