Abstract
Purpose :
While previous studies have described changes in the surgical management of rhegmatogenous retinal detachment (RRD) over time, there is limited data on variation in RRD management in a large sample. We characterize variation in practice patterns for surgical management of RRD across the United States. We investigate whether the primary drivers of variation in surgical management are characteristics that occur at the level of the patient, the physician, or geography.
Methods :
We employ multilevel mixed effects logistic regression models to assess the management of 108,300 patients with newly diagnosed RRD between 2007 and 2015 in the Truven Health MarketScan Commercial Claims and Encounters database. We estimated patients’ likelihood of receiving any surgery for their RRD, and estimated the likelihood of different surgical approaches among patients who underwent surgery (pars plana vitrectomy, scleral buckle, pneumatic retinopexy, cryotherapy, and laser barricade).
Results :
55% of patients underwent RRD repair. Patient characteristics accounted for 66% of the variation in whether patients received surgery for their RRD, with physician-level variation accounting for 33%, and geographic variation accounting for less than 1% (Figure 1). The most common surgical approach was PPV (49.3%). Geographic variation accounted for 8% of the variation in the type of surgery patients received, with provider-level variation accounting for 22%, and patient characteristics accounting for 70% (Figure 2, Table 1).
Conclusions :
While patient characteristics are the primary predictors of RRD management, physician-specific practice patterns and the prevailing practice patterns in a geographic area remain important determinants of how patients’ retinal detachments are managed. Similar patients receive different care depending on where they live and which physician they see, suggesting a need for more research on reasons underlying variation and drawing on implementation science to disseminate best practices. However, the fact that patient characteristics predict most of the variation in patient managements suggests that retinal surgeons are using the existing evidence base to inform their decisions for patient care, and are responsive to research clarifying the efficacy of different procedures in different patient populations.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.