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Yasaira Rodriguez Torres, Anshu Wadehra, Hollister Swanson, Melanie L Mihlstin, Frank Hwang; Resident Compliance with the American Academy of Ophthalmology Preferred Practice Pattern® Guidelines for Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6328.
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© ARVO (1962-2015); The Authors (2016-present)
The American Academy of Ophthalmology (AAO) developed a series of Preferred Practice Pattern® (PPP) guidelines that identify characteristics and components of quality eye care. Adherence to AAO PPP can be a helpful method of evaluating resident performance during training. The purpose of this study was to examine resident compliance with the AAO PPP for the evaluation of Diabetic Retinopathy.
515 consecutive charts were retrieved from NextGen EHR using ICD-9 code for diabetes mellitus and its related eye conditions for a retrospective chart review of patients evaluated in the Resident Clinic at the Kresge Eye Institute between October 24, 2012 and June 25, 2015 with IRB approval. Twenty-six key elements in the PPP, including 10 elements in history, 7 in physical examinations, 3 in diagnostic elements, 2 in follow up and 4 in patient education were evaluated. Compliance rates for these elements were averaged and stratified based on PGY years.
Mean compliance rate for the 10 historical elements was 50.8% (PGY2=53.2%, PGY3=51.5% and PGY4=49.7%). Lower compliance was seen in documentation of hemoglobin A1c with 27% for all charts. Mean compliance for the 7 elements in physical examination was 89.5% (PGY2=89.7%, PGY3=92.1 and PGY4=88.6) with gonioscopy being the lowest at 31.1% documentation for all charts. Mean compliance rate for the 3 diagnostic elements were 94.2% for all charts and all elements within this category had compliance higher than 75% across all PGY groups. Mean compliance for the correct recommended follow up documented was 93.6% for all charts. Mean compliance rate for patient education was 45.3% (PGY2=41.5%, PGY3=47.4% and PGY4=45.7%) with education on blood sugar control at 83.7% overall compliance.
Residents are mostly compliant with the PPP guidelines as shown by 15 elements achieving a compliance rate above 70% and 11 elements above 90% compliance. Higher documentation rates were physical exam elements with six of them above 98% compliance rate. Lower compliance was observed in documentation of hemoglobin A1c and gonioscopy. Monitoring resident adherence to these guidelines ensures the quality of patient care early in their careers and integration of evidence-based medicine into their curricula. This study also identified elements with poor compliance and these will be addressed and monitored for resident education.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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