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Brian Joondeph; Quality Measures Within a Group Retina Practice - Cultural Shift and Clinical Outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5587.
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The purpose of this project is to demonstrate the feasibility of a group medical practice instituting several quality measures, both clinical and nonclinical. This involves not only the actual measures, but also the cultural shift within the practice, which supports quality measurement and improvement.
Clinical data within an 11-physician retina-only practice was obtained over the year 2012 through the electronic medical record system. Specifically the one operation success rate for surgical repair of uncomplicated retinal detachment (RD) and macular hole (MH) were recorded, namely success 3 months following surgery. Nonclinical measures were based on two survey questions, measuring patient satisfaction with the practice and their individual physician, using a survey of 3% of patient visits for the year. Serious reportable events (SPE) for the year were collected, specifically intravitreal injections performed on the wrong eye or using the wrong medication.
Physicians within the practice showed little interest in the project but offered no resistance. The single operation success rates for repair of RD was 80% and for MH was 88%, with significant variation between physicians. Patient satisfaction scores noted 95% satisfaction with the practice and physicians. SPEs occurred with an incidence of 0.0125%. Fewer than half of the physicians wanted to know their surgical outcomes upon completion of the project.
Quality can be measured within a group retina practice but the cultural shift toward systematic quality measurement remains challenging. Measures of quality and value are important new metrics under healthcare reform and such data may provide advantages to practices under new payment mechanisms. Ultimately it is better for medical practices to proactively measure quality than to allow the government or payers to perform these measures using arbitrary or flawed metrics.
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