Resident compliance with the American Academy of Ophthalmology (AAO) Preferred Practice Patterns (PPPs) for Primary Open-Angle Glaucoma Suspects (POAGS)

Abstract

Purpose: POAG is a leading cause of irreversible blindness in the United States and other industrial countries [1-3]. Epidemiological studies found that fewer than 50% of cases of visual field loss due to glaucoma have been diagnosed [4-6]. Visual field loss and progression of glaucoma are major concerns when following patients suspected of having glaucoma or POAGS. To address these risks the AAO developed PPPs for POAGS patients based on scientific data and clinical trial data when available [7, 8]. Monitoring adherence to these guidelines ensures residents deliver quality patient care early in their careers and integrates evidence-based medicine into residency curricula [9, 10]. The purpose of this study was to examine conformance with the AAO PPPs for the evaluation of POAGS in a resident ophthalmology clinic.

Methods: 200 charts were selected for a retrospective chart review of new adult patients diagnosed with POAGS using the ICD-9 code for glaucoma suspect who underwent evaluation between Nov 2010 and May 2014 at the Kresge Eye Institute resident ophthalmology clinic. These clinic visits were evaluated for 17 different PPP elements. Compliance rates for the elements of PPPs were averaged in all charts, averaged per resident, compared among 39 residents and then were compared between 1^st, 2^nd and 3^rd year of residency.

Results: Mean compliance was 73.8% for all charts (n=200), 74.4% for 1^st residents, 74.5% for 2^nd and 73.3% for 3^rd. Compliance rates were high (>90%) for 9 elements, which included most elements of the physical examination and history. Documentation of ocular history, central corneal thickness, gonioscopy, optic nerve head and retinal nerve fiber layer analysis and visual field ranged from 40% to 80%. Documentation was lowest for patient education elements which ranged from 0% to 10%. Compliance was not significantly (P0.05) different between residents or between different resident years for any of the elements.

Conclusions: Residents’ compliance for most elements was high for most elements in the PPP guidelines for POAGS. However, documentation of patient education was very poor. Adherence to AAO PPPs 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.