Including the Patient Voice in Aesthetic Rhinoplasty Outcomes: A New Patient-Reported Outcome Tool for Rhinoplasty.

In “Development and Psychometric Evaluation of the FACE-Q Scales for Patients Undergoing Rhinoplasty,” Klassen et al1 present an exciting new patient-reported outcome (PRO) tool specific to these patients and intended to assess the aesthetic components of the procedure. Patient-reported outcomes are the patients’ feedback, elicited directly from them without interpretation by the physician or others, on how they perceive the physical, mental, or social condition related to their condition or treatment.2 The instrument described by Klassen et al1 has the potential to serve as an important new tool for the rhinoplasty surgeon. As Rhee and McMullin3 described in 2008, several outcome measures exist in facial plastic surgery. In particular, several PRO measures are available. However, the tool described by Klassen et al,1 specific to the aesthetic aspect of rhinoplasty, closes a gap for this popular procedure for which little data have previously been available. The broad health care stakeholder group, including policymakers, payers, health careprofessionals, andpatients, emphasizesqualityandperformance improvement inhealthcare. Performance improvement in any area involves the thoughtful modification of a process to improve performance and is most effectively implemented when the processes are rigorously measured with accurate measurement tools. In health care, theprocessesofhealthcaredeliveryare the targetsofperformance improvement, with quality, cost, and value (defined as the quality of care per dollar spent or cost) being the primarymeasuresofperformance.Aswestrive to improve the quality of care andachieve theTripleAimof improving the individual experience of care, enhancing the health of populations, and reducing the per capita cost of care for populations, we recognize the absolute necessity for measurement tools.4 The rhinoplasty tool described in the article by Klassen et al1 is particularly significant for enablingmeasurement of the patient’s individual experience of care, a pillar of the Triple Aim. Patient reportedoutcometools capture thevoiceof thepatient in thehealth care episode.Theyprovide information that canonly come fromthepatient, including symptomsand their frequency and the severity and effect of a condition or treatment on the patient’s disability or quality of life.5 Systematic use of PRO tools improves communication anddecisionmakingbetweenphysicians andpatients andenhancespatient satisfactionwith care.6However, despitedemonstrationsof their usefulness, to date, various barriers limit the routine implementation of PRO instruments, including technical and logistical barriers, in addition to limited instrument availability. Klassen et al1 present a tool that is easily implementable into a busy clinical practice. Their 10-item SatisfactionWith Nose Scale and 5-item Satisfaction With Nostrils Scale could be quickly completed on a tablet or in paper format at the time of the visit or from home. The scales can be seamlessly integrated into the existing practice work flow, eliciting valuable patient experience data. As noted byKlassen et al,1 rhinoplasty remains one of the most commonly performed cosmetic procedures. Furthermore, rhinoplasty presents technical challenges, with nuanced patient expectations and desires for results. For rhinoplasty specifically, few data have been available to measure aesthetic outcomes from the patient perspective. This addition to the literature describes an important new tool in facial plastic and reconstructive surgery. DevelopmentandvalidationofnewPROinstruments such as this one demand adherence to rigorous methods. The approach followedbyKlassenetal1 includes the following5steps: (1) theorization of a conceptual framework; (2) adjustment of the framework; (3) authenticationof the frameworkandevaluationof furthermeasurementproperties; (4) assembly, examination, and interpretation of data; and (5) adaption of the instrument.5 Of the available patient response types, Klassen et al1 selected a Likert-type scale format. Alternative response formats includevisual analog scales (anchoredornot), pictorial scales, rating scales (frequencyof events), andchecklists (yes or no items). In addition, PRO tools can be selfcompletedby thepatient, completedwith thepatient answeringquestions administeredby thehealth careprofessional, or a combination thereof. Klassen et al1 implemented the patient completion option with their tool. Insummary,Klassenetal1 introducean importantnewPRO instrument to the literature to enablemeasurement of thepatient perspective of the appearance of the nose. The authors adhered to strictmethods, enabling us to begin further investigation of test-retest reliability and to evaluate the ability of the scales tomeasure changebefore andafter rhinoplasty. For Related article page 27 The FACE-Q Scales for Patients Undergoing Rhinoplasty Original Investigation Research