Establishing a Formal Pituitary Center of Excellence: From Criteria to Implementation

Introduction: Growth of healthcare systems and specialization within medicine has sparked the development of centers of excellence (COE) for coordinated delivery of complex care, including management of pituitary disease. Volume criteria for the establishment of a pituitary center of excellence (PCOE) have been extensively discussed but definable benchmarks are absent, leading to self-identification as PCOE by several centers.

Objective: To review suggested criteria for the establishment of PCOE, present the necessary and practical steps taken for creation of a PCOE, and define the regular practice patterns and benchmarks which ensure maintenance and growth of such a center.

Results: A patient-centric and evidence-based system providing comprehensive and definitive care is the goal of a PCOE. Suggested criteria for PCOE creation include surgical volume of at least 50 cases per year, subspecialized physicians and surgeons adept in both endonasal and transcranial approaches, access to diagnostic/clinical tools, outcomes thresholds, and follow-up capabilities in addition to educational and research goals. Continual outcome improvement, education, and increased efficiency demonstrated over time are additionally sought features. Creation of single site multidisciplinary clinics, multidisciplinary conferences, regular assessment of complications, and incorporation with a residency/fellowship program all assist in achieving those ends. In particular, tracking outcomes prospectively and utilization of dashboard electronic medical record (EMR) applications can facilitate ongoing quality improvement and set clear benchmarks within a healthcare system. As such, maintenance of criteria thresholds for accessible data such as cerebrospinal fluid (CSF) leak rate, postoperative hypopituitarism, length of hospital stays, and readmission rates allows for relative ease of tracking and certification within a system or health plan. Likewise, participation in national registries and/or data-sharing may assist to a similar end and allow for more widespread, consistent adoption.

Conclusion: Implementation of the criteria for a PCOE requires a deliberate and committed effort to outcome improvement and needs to be demonstrated over time rather than at a singular moment. Regular quality monitoring is essential toward placing criteria into practice; PCOEs are achieved not only via collection of data but ongoing multidisciplinary efforts with the aim of improving outcomes and providing a defined standard of care.

 

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Artikel online veröffentlicht:
15. Februar 2022