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Jia Yin, Melanie Mihlstin, Mark McDermott, Frank Hwang; Resident Compliance with the American Academy of Ophthalmology Preferred Practice Pattern® Guidelines for Conjunctivitis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6195.
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© ARVO (1962-2015); The Authors (2016-present)
The American Academy of Ophthalmology (AAO) developed a series of Preferred Practice Pattern® (PPP) guidelines that identify characteristics and components of quality eye care based on the best available scientific data as interpreted by panels of experts. Monitoring resident adherence to these guidelines ensures the quality of patient care early in their careers and integration of evidence-based medicine into their curricula. The purpose of this study was to examine resident conformance with the AAO PPP for the evaluation of conjunctivitis.
One hundred and fifty consecutive charts were retrieved from the NextGen EHR using ICD-9 code 372.30 for conjunctivitis for a retrospective chart review of patients newly diagnosed with conjunctivitis and evaluated in the Resident Clinic at the Kresge Eye Institute between October 2013 and October 2014 with IRB approval. Twenty-four key elements in the PPP, including 12 elements in history, 10 in physical examinations, and 2 in patient education, were evaluated. Compliance rates for these elements were averaged and stratified based on PGY years.
Mean compliance of all elements was 68.5% for all charts (PGY2=69.2%, PGY3=68.2% & PGY4=66.9%). Mean compliance rate for historical factors were 60.1% (PGY2=60.1%, PGY3=62.6% and PGY4=58.5%) with lower compliance (<40%) in documenting exacerbating factors, discharge, sick contacts, trauma and contact lens wear. Mean compliance for physical examination was 79.8% (PGY2=79.9%, PGY3=79.5% and PGY4=80.0%) with only two factors with <90% compliance, skin and dye-staining pattern. Mean compliance rate for patient education was 55.8% (PGY2=69.9%, PGY3=45.8% and PGY4=51.7%).
Residents are mostly compliant with the PPP guidelines in their physical examination, and moderately compliant with patient history and education. Adherence to AAO PPP can be a helpful method of evaluating resident performance during training. A target level of compliance should be set and maintained to ensure that residents are developing quality and evidence-based patient care skills. This study also identified elements with poor compliance and these will be addressed and monitored in resident education and practice.
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