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Elliot S Crane, Loka Thangmathesvaran, Kunjal K Modi, Albert S Khouri; Optic Nerve Exam PQRS Compliance in Glaucoma Tube Shunt Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5047.
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To compare resident and attending compliance with the Physician Quality Reporting System (PQRS) standards for primary open angle glaucoma (POAG) in a population of patients undergoing tube shunt surgery regardless of glaucoma type. As per PQRS guidelines, one optic nerve exam needs to be performed per reporting period.
Patients who underwent tube shunt surgery for glaucoma at Rutgers New Jersey Medical School between 2008 and 2015 and had a minimum of six months of follow up were included. The pre-surgical optic nerve exam date and cup to disc (C/D) ratio taken closest to the time of surgery was noted. In cases where no optic nerve exam was performed, documentation as to why the exam was not performed was recorded if present. T-tests and Fisher’s exact tests were used for analysis; α=0.05.
148 eyes of 128 patients were included in the study. 58 cases (39.2%) were performed by residents. Optic nerve exams were performed in 51/58 (87.9%) of resident cases and 86/90 (95.5%) of attending cases (P=0.087). Exams were not performed due to documented medical necessity in 6/58 (10%) resident cases and 3/90 (3.3%) attending cases (P=0.093). One of 58 (1.7%) resident cases had no exam with no documentation present. Optic nerve drawings replaced specific cup to disc ratios in 8/51 (15.7%) resident cases and 49/86 (57%) attending cases who had a documented exam. The mean ± standard deviation (SD) C/D ratio was 0.851 ± 0.155 among the 79 cases with documentation. The mean ± SD time between the pre-operative exam and tube shunt surgery was 50.16 ± 54.54 days for resident cases and 55.64±73.02 days for attending cases (P=0.62). Within one year of tube shunt surgery, 53/58 (91%) resident cases and 88/90 attending cases (98%) had optic nerve exams or a documented medical necessity for not performing one (P=0.052).
Although the optic nerve exam requirement applies only to patients with POAG, we analyzed this criteria for patients with all types of glaucoma who underwent tube shunt surgery. Resident and attending compliance with PQRS for optic nerve evaluation was high. 98.60% of patients either had an optic nerve exam performed or a documented reason was provided for why it was not completed within one year prior to the surgery.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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