Abstract
Purpose: :
To evaluate rates of vision screening (VS) and the Achievable Benchmark of Care (ABC) using objective, practice-based measures of VS at ages 3, 4, and 5 years during three annual periods. The ABC shows the rates achieved by a subgroup of the top performing primary care providers (PCPs) using measures routinely obtained in real world settings
Methods: :
We obtained all claims for Well Child Visits (WCVs) and quantitative VS (reimbursed separately) from Alabama Medicaid filed during 3 annual periods between 10/1/02 and 7/17/07. Eligible providers filed at least one WCV and VS during the relevant time period. After adjusting the data for small denominators, we ordered each provider sequentially in descending order until the subset of providers included at least 10% of children. The ABC was calculated as the total number of patients in the subset with VS divided by the total number of patients in the subset with a WCV.
Results: :
Among this subset of providers, the median counts per provider were zero VSs for 3 year olds and 2 VSs for 4 year olds at all time periods. Average rates of VS per provider were below 20% for 3 year olds, below 35% for four year olds, and below 60% for 5 year olds at all time periods. "Best" providers, whose VS rates were at or above the ABC, screened at least 68.3% of 3 year olds, 79.4% of 4 year olds and 93.2% of 5 year olds during time period 1. The ABC increased for each age at later time periods.
Conclusions: :
We found a large variation in the rates of preschool VS among primary care providers, with many providers not screening any of the younger children. However, a subset of primary care providers met or exceeded the ABC at each age indicating that high rates of VS can be achieved in real world settings.
Keywords: amblyopia • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • screening for ambylopia and strabismus