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M.S. Juzych, A.K. Shukairy, B.A. Hughes, A. Gupta, M. Syed, M. Bagga, C. Kim; Glaucoma Care and Conformance with Preferred Practice Patterns in a Resident Clinic Setting . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3390.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the conformance with preferred practice patterns of care for patients with open–angle glaucoma and open–angle glaucoma suspect in a resident clinic setting. Results will be used as a baseline for resident ACGME system–based practice competency educational intervention.
A retrospective analysis of 199 charts of patients with either open–angle glaucoma or glaucoma suspect from the Resident Clinic at Kresge Eye Institute was conducted. Charts were evaluated for conformance with the Preferred Practice Patterns (PPP) set forth by the American Academy of Ophthalmology for primary open–angle glaucoma and primary open–angle glaucoma suspect. Analysis focused on the performance of specified examination steps at the initial and follow–up visits. The initial evaluation was set as the first 3 visits, as defined by the PPP.
Documentation of examination findings for new patients during the initial evaluation was 100% for slit–lamp and pupil examinations, 100% for intraocular pressure measurement (IOP), and 95% for C:D ratio documentation . During the initial evaluation, 69% of patients received or were scheduled for gonioscopy, and visual fields were obtained or scheduled in 95%. For return patients, 100% had slit–lamp and pupil examinations, as well as IOP measurement. Within 1 year of the exam date, 97% of return patients had a dilated fundus examination and 62% had an optic nerve head drawing and/or photograph. Visual field testing occurred at intervals of 1 year or less in 84% of return patients. A modification in treatment occurred for 21% of patients, yet occurred significantly more often for patients classified as having moderate–severe disease compared to the mild disease group as defined by the PPP. Target IOP was documented in 12% of patient charts on the exam date. Based on severity of glaucomatous disease, time intervals for scheduled follow–up visits were consistent with PPP recommendations.
Many aspects of patient examination were found to be consistent with the PPP. However, conformance with PPP was found to be substandard for gonioscopy, optic nerve head photography and/or drawing, and target IOP documentation. Consideration should be made for inconsistent patient show rates as well as variability of resident physician care typical of a resident clinic setting. Evaluation of resident physician conformance to PPP has many implications for the quality of glaucoma care and treatment. Results of this study are relevant for continuous quality improvement as defined by the ACGME Competencies.
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