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P. K. Gupta, S. F. Freedman, P. P. Lee; Conformance With Preferred Practice Patterns in Caring for Children With Esotropia. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1446.
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To evaluate documentation of initial esotropia (ET) evaluations, with respect to history, physical exam, care management and patient education, for the presence of key elements as defined in the AAO’s Summary Benchmarks for Preferred Practice Patterns.
A retrospective chart review was done using 50 charts from 6 physician practices. A random sample was selected for review among patients younger than 10 years old and diagnosed with ET of all types from January 1, 2000 and November 30, 2007 at the Duke University Eye Center. Charts were reviewed for documentation of the key elements of the initial evaluation history (signs/symptoms, ocular history, systemic history, and family history), physical exam (7 parameters as age appropriate), and care management with patient education (discussion and formulation of plan with parents, consideration of ET type, refractive error correction, surgical intervention, and amblyopia treatment as indicated), as defined in the AAO’s Summary Benchmarks for 2007. The presence or absence of each of the key elements was recorded. The average number of key elements documented was calculated overall and for each subset.
On average, 72% of the key elements in the history portion of the evaluation were documented (range 50-100%). Full documentation (presence of 2/3) of the ocular symptoms and signs (date of onset, frequency of deviation, and presence or absence of diplopia or squinting) as well as full documentation of family history (specifically presence or absence of 2/4 of the following: strabismus, amblyopia, extraocular muscle surgery, and genetic disease) were most often missed. On average, 90% of the key elements in the initial physical exam were documented (range 83 to 100%). The presence or absence of nystagmus was most often missed in documentation. On average, 93% of the key elements with respect to care management and patient education were documented. Overall, on average 86% of all initial evaluation key elements were documented.
The process quality of care in a tertiary academic center for strabismus conforms well to professional practice patterns. However, significant opportunities for improvement do exist. Additional data are needed from other practice settings and for other conditions to assess the quality of care for children.
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