Resident compliance with the American Academy of Ophthalmology (AAO) Preferred Practice Patterns (PPPs) for Dry Eye Syndrome (DES)

Abstract

Purpose: Though DES is not usually sight-threatening, severe cases can result in keratinization, thinning, perforation, and scarring of the cornea, thus leading to severe visual loss. To address such concerns, the AAO developed PPPs for proper diagnosis and management of DES. This study examined compliance with the AAO PPPs for evaluation of DES in a resident ophthalmology clinic.

Methods: 101 chart notes were chosen to retrospectively evaluate patients newly diagnosed with DES and evaluated by residents in the resident ophthalmology clinic at Kresge Eye Institute between September 2011 and November 2014. Each chart note was evaluated for 29 different PPP elements. Average compliance rates of all elements were found in all charts, and then compared between 1^st, 2^nd, and 3^rd year residents.

Results: Mean compliance of all elements was 70.0% for all charts, 69.1% for 1^st year residents, 71.2% for 2^nd year residents, and 70.7% for 3^rd year residents. Mean compliance of historical elements was 74.2%, with low compliance (<25%) in documenting contact lenses wear, eyelid/eyelash hygiene, and menopause in female patients. Mean compliance of physical exam elements was 55.6%, with high compliance (>90%) in documenting best corrected visual acuity (BCVA) and examination of eyelids/lashes, tear film, conjunctiva, and cornea; and low compliance (<40%) in documenting proptosis, cranial nerve examination, and examination of adnexa and puncta. Mean compliance of patient education elements was 51.5%, with high compliance (99.0%) in documenting instructions on treatment regimen and very low compliance (4.0%) in documenting counseling on the chronic nature of DES. Compliance of the only evaluated care management element, addressing contributing factors, was 62.4%. Significant differences in each element between residents of different years is currently undergoing statistical analysis and will be ready to present on poster day at ARVO.

Conclusions: Compliance was high for most elements in the PPP guidelines for DES. However documentation of specific historical, physical exam, and patient education elements was poor. Evaluating compliance with AAO PPPs can be useful for evaluating resident administration of care. Setting and maintaining a target compliance rate will ensure that residents develop the necessary skills in proper and evidence-based patient care.