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P. B. Veldman, A. S. Shah, T. C. Chen; Assessing the Validity of the 2010 PQRI Post Cataract Visual Acuity Measures: A Comparison of Post Operative Acuity Between Experienced and Less Experienced Resident Cataract Surgeon Cohorts. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5441.
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© ARVO (1962-2015); The Authors (2016-present)
The 2006 Tax Relief and Health Care Act established the Physician Quality Reporting Initiative (PQRI), whose premise is that higher quality care should be reimbursed more. A new 2010 PQRI outcome measure asks surgeons to report if "20/40 or better visual acuity within 90 days following (cataract) surgery" is achieved. The purpose of this study is to assess the efficacy and validity of this measure as a proxy for quality delivery of cataract surgery.
A retrospective review was conducted analyzing the post-operative outcomes of cases performed by two cohorts of resident cataract surgeons with disparate operative experience. The first cohort consisted of four third year residents during the final two months of their residency. The second cohort included seven residents during the first two months of their third residency year. Post-operative visual acuity outcomes were collected and compared with respect to these two groups. After controlling for case complexity and adequacy of follow-up, as well as excluding cases where co-morbid conditions may have affected post-operative outcomes (i.e. macular degeneration, glaucoma, amblyopia, diabetic macular disease, and other macular pathology), 81 cataract extractions (48 from the first cohort, 33 from the second cohort) were included in the final analysis. Cases were evaluated utilizing the 2010 PQRI measure of "20/40 or better visual acuity within 90 days."
Of the 48 included cases performed by the first cohort of May-June resident surgeons, 48 (100%) of the cases achieved 20/40 visual acuity within 90 days post-op, while 31 (91.2%) of the 34 cases performed by the July-August resident surgeons achieved this acuity. A Fisher’s test comparing the two cohorts gave a p-value of .0675, failing to show statistical significance.
The "20/40 in 90 days" acuity measure was unable to show a statistically significant difference between the post-operative outcomes of July-August resident surgeons and May-June resident surgeons. Additionally, the fact that 100% of the May-June resident cases evaluated achieved this PQRI outcome measure raises the question of whether this measure will have sufficient sensitivity to differentiate cataract outcomes among resident and attending surgeons. This study concludes that further analysis will be needed before this measure can be utilized as an accurate gauge of quality healthcare delivery.
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