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P. P. Lee, D. Lobach, G. McGwin, Jr., W. Rafferty, M. Hunt, E. Postel, L. Branch; Short-Term Changes in Diabetes Eye Care From Interventions to Improve Process of Care. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4903.
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Prior work has shown that community-based optometrists and ophthalmologists perform less than 65% of the elements of care recommended by the AAO and AOA practice guidelines. As part of an ongoing study of interventions (1 - CME only; 2 - CME plus templated chart notes and office posters; 3 - CME plus tablet computer with decision support system) to improve the process quality of care, we sought to assess the extent of changes in the short-term (3 to 8 months) after intervention implementation.
As part of a planned short-term assessment for the study, providers responded to open-ended vignettes about the management of new and follow-up patients with diabetes and diabetic retinopathy. Work in other fields suggests that vignettes are a valid and reliable proxy for chart review and simulated patients. We analyzed the content of the first 60 of 96 providers’ reports of what they would typically do for these patients and then compared the scores to baseline scores using linear regression, controlling for their baseline scores. At baseline, no differences existed for any component of the evaluation.
The vignette reported content of care did not change for those providers who received only a CME course. Scores increased by at least 8 points (out of 100) in the high technology (tablet computer) and low technology (templated paper form and office poster) for diabetes history taking and elements of the fundus exam, However, there was no difference on other aspects of history taking and examination elements, nor in total evaluation score.
Use of both high and low technology interventions had only a moderate impact on process quality of care as measured by vignette responses by providers in the short-term. Comparison to analyses with actual chart abstraction for process quality of care (currently underway) will be critical to understanding whether the interventions will have a larger impact as well as the means by which such interventions affect care, since the vignettes responses suggest that the interventions result in only a modest incorporation of care patterns in the providers’ consciousness.
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