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D. Lobach, P. Lee, E. Postel, W. Rafferty, G. McGwin, L. Branch; Process Quality in the Care of Patients with Diabetes Mellitus . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4416.
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Studies have indicated significant shortfalls in the process quality of care of patients with chronic diseases across all fields of medicine, using chart review, simulated patients, and written clinical vignettes. However, data on the process quality of care for diabetes mellitus (DM) eye care is limited. As part of the baseline assessment of the eye care of patients with DM in a randomized trial of interventions to enhance the use of evidence–based eye care, we used clinical vignettes to determine how ophthalmologists and optometrists care for patients with DM relative to practice guidelines.
Participants in the study completed a baseline survey which included clinical vignettes for new and continuing patients with DM. Responses were coded according to a standard protocol based on the specific recommendations for care of the American Academy of Ophthalmology's Preferred Practice Pattern (PPP) and the American Optometric Association recommendations. Unweighted scores of conformance with specific items in the history and examination of patients were converted to a 0 to 100 score.
Data from the first 71 of 98 enrolled provider surveys demonstrated that the mean scores were: 1) new patient history – 64 (+19); 2) new patient examination – 66 (+22); 3) follow–up history – 75 (+15); and 4) follow–up exam – 61 (+22). Specific items of importance in the initial history included 89% for the duration or age of onset of DM; 87% for glucose status; 41% for hypertension status; and 24% for lipid status. New patient exam scores varied from 25% for gonioscopy when indicated to 92% for IOP and a detailed slit lamp exam.
While scores were better than those reported for other systemic chronic diseases by McGlynn, et al from administrative data and chart reviews, these estimates of process quality by vignettes indicate significant opportunity for innovative methods to improve the quality of eye care for patients with DM. The current study will also seek to validate the use of clinical vignettes relative to chart reviews as part of the study goals.
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