The QuEST (Quality, Efficiency, Satisfaction and Training) initiative is a continuous quality improvement project through aimed at answering three questions across all areas of our practice:
Our goals include improving:
Our first project focuses on developing and implementing evidence-based guidelines to support clinical decisions and reduce the variability in care provided. In the past two years we have developed and implemented four clinical management pathways, with several others in development. The treatment of adolescent varicoceles pathway was the first to be implemented and measured. The literature is inconsistent as to the treatment of varicoceles, and management varies considerably throughout the nation and within our own practice.
A workgroup of providers developed the pathway based on feedback from their peers and available literature. The goal of the pathway is to set a standard for follow-up imaging, semen analysis and surgery. We agreed that patients with a testicular volume differential of less than 15 percent should have a scrotal ultrasound every two years; those with a discrepancy of more than 15 percent would be seen annually; persistent discrepancy on three studies warranted surgery; and all patients should submit a semen analysis at age 18.
Data on adherence to the pathway and patient outcomes is reviewed quarterly. Since inception, the data has shown a reduction in practice variation with more than 90 percent compliance to the pathway. The algorithm has led to an effective, low-cost means of following this patient population. We believe that prospective data collection will allow us to assess the relationship between total testicular volume and semen analysis parameters; data that will guide care moving forward.
In the coming year, we will extend the pathway program to include problems like daytime and nighttime wetting, stone disease, spina bifida and antenatally detected hydronephrosis. We will also routinely measure patient and provider satisfaction and the cost of care. However, the most important focus of this work will be on patient outcomes: Is the care we are providing resulting in the best outcomes for our patients? Continuous monitoring of our clinical data will help us ensure we are providing the right care to the right patient at the right time – every time.