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C. Yu, A. Madu; Improving Adherence to Preferred Practice Patterns Guideline and Reducing Disparities in Evaluation of Bacterial Keratitis by Educational Intervention. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5045.
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Preferred practice patterns (PPP) published by American Academy of Ophthalmology are designed to identify characteristics and components of quality eye care based on updated scientific data and consensus among a panel of subspecialty experts. The purpose of this study is to investigate the adherence to PPP guidelines for the evaluation, diagnosis, and treatment of bacterial keratitis in our practice and to evaluate the impact of educating residents on practice patterns for bacterial keratitis.
Twenty charts with a diagnosis code of bacterial keratitis from our resident clinic were reviewed. Adherence to the PPP guidelines on obstaining history, documentation of physical examination, diagnostic tests, and treatment were evaluated. An educational lecture on bacterial keratitis and an evidence-based algorithm for evaluating patients with suspected bacterial keratitis were presented to the residents. Twenty charts were subsequently reviewed two months after the lecture to evaluate adherence to the PPP guidelines. Statistical analysis was performed using chi-square test.
Among the twenty charts reviewed before the educational intervention, documentation for history of present illness was adherent to PPP guidelines in seventeen charts (85%). Compliance in documentation for adnexa examination was observed in fifteen charts (75%), whereas compliance in cornea examination documentation was observed in six charts (30%). All twenty charts were adherent for appropriate diagnostic workup and treatment. Charts reviewed after the educational intervention showed significant improvement in adherence to PPP guidelines for adnexa examination (100%, p=0.047) and cornea examination (80%, p=0.004). A trend for improved adherence to documenting history was also found (100%, p=0.23).
Educating residents using evidnece-based medicine and current practice recommendation improved adherence to the preferred practice patterns guidelines for bacterial keratitis and enhanced quality of patient care. By developing an evidence-based algorithm and educating residents on specific topics, disparities in evaluation and treatment of eye diseases can be minimized.
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