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Schlenker MB, Samet S, Lim M, D’Silva C, Reid RJ, Ahmed IIK. Physician and patient concordance in reporting of appropriateness and prioritization for cataract surgery. PLoS One 2021; 16:e0253210. [PMID: 34170915 PMCID: PMC8232411 DOI: 10.1371/journal.pone.0253210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/29/2021] [Indexed: 11/26/2022] Open
Abstract
Background/Aims Determine the association between physician-deemed and patient-reported appropriateness and prioritization for cataract surgery. Methods Prospective cohort study of 471 patients of 7 ophthalmologists referred for cataract surgery. Ophthalmologists rated patients for cataract surgery appropriateness and prioritization using a visual analogue scale of 0–10 preoperatively. All patients completed the eCAPS Quality of Life (QoL), while 313 completed the Catquest-9SF and EQ-5D questionnaires. Regression analyses were applied to determine demographic, clinical and patient-reported outcome measures (PROMs) associated with appropriateness and prioritization. Results Two clinical factors (study eye and fellow eye best-corrected visual acuity (BCVA)), 2 eCAPS (night driving difficulty, ability to take care of local errands), and 2 Catquest-9SF PROMs (recognizing faces, seeing to walk on uneven ground) were associated with appropriateness. In multivariable regression, the rating physician, 2 clinical criteria (study eye BCVA, anticipated postoperative BCVA) and 1 eCAPS QoL (night driving difficulty) were associated with appropriateness. Prioritization was associated with low income, 8 clinical criteria, 9 eCAPS, 5 Catquest-9SF, and 1 EQ-5D PROMs. In multivariable regression, 1 clinical criterion (study eye BCVA), 2 eCAPS QoL (night driving difficulty, ability to take care of local errands), and 2 Catquest-9SF PROMs (seeing prices, seeing to walk on uneven ground) were significantly associated. Conclusions The eCAPS and Catquest-9SF questionnaires show some concordance with physician-deemed appropriateness, and more with prioritization. Binary conversions of PROM scales provide similar modelling, with minimal loss of explanatory power. As physician-deemed appropriateness and prioritization do not completely capture the patient perspective, PROMs may have a role in cataract surgery decision-making frameworks.
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Affiliation(s)
- Matthew B. Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Prism Eye Institute, Oakville, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- * E-mail:
| | - Saba Samet
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Prism Eye Institute, Oakville, Ontario, Canada
| | - Morgan Lim
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Chelsea D’Silva
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Robert J. Reid
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Iqbal Ike K. Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Prism Eye Institute, Oakville, Ontario, Canada
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Barriers and facilitators for implementation of a patient prioritization tool in two specialized rehabilitation programs. JBI Evid Implement 2021; 19:149-161. [PMID: 33843768 DOI: 10.1097/xeb.0000000000000281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Prioritization tools aim to manage access to care by ranking patients equitably in waiting lists based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool (PPT) with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a PPT in rehabilitation programs. METHODS We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on the Consolidated Framework for Implementation Research. RESULTS Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes for patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process. CONCLUSION This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers' perspective.
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Predicting changes in cataract surgery health outcomes using a cataract surgery appropriateness and prioritization instrument. PLoS One 2021; 16:e0246104. [PMID: 33507910 PMCID: PMC7842922 DOI: 10.1371/journal.pone.0246104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/13/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Determine whether items in a cataract surgery appropriateness and prioritization questionnaire can predict change in best corrected visual acuity (BCVA) and health related quality of life (HRQOL) following cataract surgery. Methods 313 patients with a cataract in Ontario, Canada were recruited to participate. BCVA was measured using the Snellen chart. HRQOL was measured using a generic instrument (EQ5D), a visual functioning instrument (Catquest-9SF), and an appropriateness and prioritization instrument (17 items). Outcomes were measured preoperatively and 3–6 months postoperatively. Descriptive statistics were used to describe demographics and outcomes. For each appropriateness and prioritization questionnaire item, a one-way ANOVA was used to compare group means of the change in BCVA, EQ5D, and Catquest-9SF. Results Participants had a mean age of 69 years and were 56% female. BCVA improved in 81%, EQ5D in 49.6%, and Catquest-9SF score in 84% of patients. Improvement in both BCVA and Catquest-9SF scores were found in 68.5% of patients. The ANOVA showed a statistically significant association between a change in BCVA and the ability to participate in social life, and a statistically significant association between a change in Catquest-9SF and glare, extent of impairment in visual function, safety and injury concerns, ability to work and care for dependents, ability to take care of local errands, ability to assist others and ability to participate in social life. Conclusions Almost all patients had improved BCVA and/or visual functioning after surgery. Seven variables from the cataract appropriateness and prioritization instrument were found to be predictors of improvement in Catquest-9SF measuring visual functioning.
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Déry J, Ruiz A, Routhier F, Bélanger V, Côté A, Ait-Kadi D, Gagnon MP, Deslauriers S, Lopes Pecora AT, Redondo E, Allaire AS, Lamontagne ME. A systematic review of patient prioritization tools in non-emergency healthcare services. Syst Rev 2020; 9:227. [PMID: 33023666 PMCID: PMC7541289 DOI: 10.1186/s13643-020-01482-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings. METHODS We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently. RESULTS We included 48 studies listing 34 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two-thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients. CONCLUSIONS This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018107205.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Angel Ruiz
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.,Faculty of Business Administration, Université Laval, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Valérie Bélanger
- Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada.,Department of Logistics and Operations Management, HEC Montréal, Montréal, Canada
| | - André Côté
- Faculty of Business Administration, Université Laval, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Centre de recherche en gestion des services de santé, Université Laval, Québec, Canada
| | - Daoud Ait-Kadi
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada.,Department of Mechanical Engineering, Université Laval, Québec, Canada
| | - Marie-Pierre Gagnon
- Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Faculty of Nursing, Université Laval, Québec, Canada
| | - Simon Deslauriers
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Ana Tereza Lopes Pecora
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Eduardo Redondo
- Faculty of Business Administration, Université Laval, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada
| | - Anne-Sophie Allaire
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada. .,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.
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Do VQ, McCluskey P, Palagyi A, White A, Stapleton FJ, Carnt N, Keay L. Patient perspectives of cataract surgery: protocol and baseline findings of a cohort study. Clin Exp Optom 2018; 101:732-739. [PMID: 29675867 DOI: 10.1111/cxo.12686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 01/19/2018] [Accepted: 03/07/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are becoming increasingly recognised as a key component in assessing the relative effectiveness of cataract surgery. This manuscript presents the protocol methodology and baseline characteristics of a prospective cohort study investigating patient-centred predictors of cataract surgery outcomes. METHODS Patients with bilateral cataract (aged ≥ 50 years) scheduled for their first eye cataract surgery were recruited at four public hospitals and three private ophthalmology clinics in Sydney, Australia. Participants underwent a comprehensive assessment of clinical measures of vision (for example, visual acuity, contrast sensitivity) and PROMs prior to first eye surgery and three months after first and second eye surgery. The PROMs of interest included health-related quality of life, visual disability and satisfaction with vision. RESULTS The characteristics of the baseline cohort of 359 participants are reported in this manuscript. Enrolment occurred over a two-year period with the majority recruited from urban public hospitals (96 per cent, n = 345). Health-related quality of life was scored highly (80 out of 100). Self-reported visual disability was considered within normal ranges compared to cataract populations in other high-income countries (-0.94 logits). Three-quarters of participants (n = 263/351) were dissatisfied with their pre-operative vision. CONCLUSIONS There is a complex and wide range of patient-centred experiences prior to first eye cataract surgery in the public hospital setting. Gaining further insight into the patient perspective may allow eye health professionals to more appropriately time surgery, better manage patient expectations and provide direction for future prioritisation initiatives of cataract wait lists. Companion papers will follow, detailing results of surgery in terms of PROMs.
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Affiliation(s)
- Vu Quang Do
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anna Palagyi
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew White
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona J Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole Carnt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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Do VQ, McCluskey P, Palagyi A, Stapleton FJ, White A, Carnt N, Keay L. Are cataract surgery referrals to public hospitals in Australia poorly targeted? Clin Exp Ophthalmol 2017; 46:364-370. [PMID: 28881411 DOI: 10.1111/ceo.13057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/24/2017] [Accepted: 08/31/2017] [Indexed: 11/29/2022]
Abstract
IMPORTANCE Referral letters constitute the first step on the pathway to cataract surgery; however, little is known on how effective referral letters are in providing adequate information to triage patients and inform surgical prioritization. BACKGROUND Benchmarking exercises are important to document referral processes and to identify areas where improvements can be made. DESIGN Cross-sectional study with longitudinal follow-up conducted at two metropolitan public hospitals in New South Wales, Australia. PARTICIPANTS A total of 400 sequential cataract referral letters. METHODS An audit of cataract referral letters was performed and content benchmarked against international prioritization tools. Medical records were reviewed 1 year following referral. MAIN OUTCOME MEASURES Referral quality and waiting times. RESULTS Two-thirds of patients referred for cataract surgery were yet to have their initial hospital appointment in the year following referral (65%, 245/376). One half of referrals seen in clinic (49%, 64/113) were not listed for cataract surgery. Multivariate analysis revealed referral letter content was not indicative of surgical booking, with the major predictors being hospital-recorded visual acuity and grading of cataract (P < 0.0001). Referral content lacked sufficient detail to apply prioritization tools developed in other settings. CONCLUSION AND RELEVANCE This audit highlights a disconnect between referral letter content and hospital assessment of patients. Current referrals to public hospitals are poorly targeted, with high numbers of referred patients not proceeding to surgery. Patients commonly waited over 1 year to have their ophthalmic assessment at these public hospital eye clinics, revealing lengthy 'wait-for-waits' as a barrier to care. Standardized referral templates may facilitate improvement of referral pathways and shorten waiting times.
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Affiliation(s)
- Vu Quang Do
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona J Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew White
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Carnt
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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7
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Predictors of functional vision changes after cataract surgery: the PROVISION study. Can J Ophthalmol 2016; 51:265-270. [DOI: 10.1016/j.jcjo.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 12/18/2015] [Accepted: 02/16/2016] [Indexed: 11/19/2022]
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Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J. Indication for cataract surgery. Do we have evidence of who will benefit from surgery? A systematic review and meta-analysis. Acta Ophthalmol 2016; 94:10-20. [PMID: 26036605 PMCID: PMC4744664 DOI: 10.1111/aos.12758] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/06/2015] [Indexed: 12/16/2022]
Abstract
The need for cataract surgery is expected to rise dramatically in the future due to the increasing proportion of elderly citizens and increasing demands for optimum visual function. The aim of this study was to provide an evidence-based recommendation for the indication of cataract surgery based on which group of patients are most likely to benefit from surgery. A systematic literature search was performed in the MEDLINE, CINAHL, EMBASE and COCHRANE LIBRARY databases. Studies evaluating the outcome after cataract surgery according to preoperative visual acuity and visual complaints were included in a meta-analysis. We identified eight observational studies comparing outcome after cataract surgery in patients with poor (<20/40) and fair (>20/40) preoperative visual acuity. We could not find any studies that compared outcome after cataract surgery in patients with few or many preoperative visual complaints. A meta-analysis showed that the outcome of cataract surgery, evaluated as objective and subjective visual improvement, was independent on preoperative visual acuity. There is a lack of scientific evidence to guide the clinician in deciding which patients are most likely to benefit from surgery. To overcome this shortage of evidence, many systems have been developed internationally to prioritize patients on waiting lists for cataract surgery, but the Swedish NIKE (Nationell Indikationsmodell för Katarakt Ekstraktion) is the only system where an association to the preoperative scoring of a patient has been related to outcome of cataract surgery. We advise that clinicians are inspired by the NIKE system when they decide which patients to operate to ensure that surgery is only offered to patients who are expected to benefit from cataract surgery.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology Rigshospitalet ‐ Glostrup Glostrup Denmark
- Danish Health and Medicines Authorities Copenhagen Denmark
| | | | - Ditte Erngaard
- Department of Ophthalmology Næstved Hospital Næstved Denmark
| | | | - Britta Tendal
- Danish Health and Medicines Authorities Copenhagen Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology Aarhus University Hospital NBG Aarhus Denmark
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Abstract
PURPOSE To assess the construct validity and responsiveness of the EuroQoL-5D (EQ-5D) instrument in Asian patients undergoing cataract surgery in Singapore. METHODS In this prospective study, English- or Chinese-speaking patients (n = 216) completed the EQ-5D and the VF-14 questionnaires before and 3 months after they underwent cataract surgery. The impact of cataracts on patients was assessed using two standard gamble (SG) questions before surgery. Construct validity of the EQ-5D index and the visual analog scale (VAS) was assessed by examining their correlation with the VF-14 and SG scores. Responsiveness of the EQ-5D was compared with that of the VF-14 in terms of the magnitude of score change associated with cataract surgery. RESULTS We found that the EQ-5D index correlated with VF-14, SG (death), and SG (blindness) (Pearson r = 0.30, 0.23 and 0.24, respectively; p < 0.01). In contrast, we found no correlation between the EQ-VAS, VF-14, and SG scores. The mean EQ-5D index (difference, 0.06; effect size, 0.35) and VF-14 score (difference, 1.75; effect size, 0.97) of patients improved after cataract surgery (p < 0.0001). CONCLUSIONS Our study demonstrated that the EQ-5D utility index is a valid and responsive outcome measure for evaluating the impact of cataract surgery in our Asian population. However, the implications of using the generic EQ-5D instrument to assess the cost-effectiveness of surgical interventions for visual impairment require further investigation.
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Developing a universal tool for the prioritization of patients waiting for elective surgery. Health Policy 2013; 113:118-26. [DOI: 10.1016/j.healthpol.2013.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 06/07/2013] [Accepted: 07/04/2013] [Indexed: 11/17/2022]
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Coronini-Cronberg S, Lee H, Darzi A, Smith P. Evaluation of clinical threshold policies for cataract surgery among English commissioners. J Health Serv Res Policy 2012; 17:241-7. [PMID: 22969092 DOI: 10.1258/jhsrp.2012.012023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To ascertain if access to cataract surgery is being restricted in England and to describe any explicit threshold criteria. METHODS A survey of 151 local commissioners to explore their cataract surgery policy. A literature review identified research evidence about thresholds for cataract surgery. A checklist was devised and applied to the policies supplied by commissioners. RESULTS Almost half (71/151) of commissioners were restricting access to surgery and this included patients with some capacity to benefit. There was wide variation in the scope and content of the 67 policies which were available for review. Almost all (92%) commissioners use criteria that do not reflect guidance or research evidence. CONCLUSIONS Patients who could benefit from cataract surgery are being excluded by some commissioners. Variations in policy between commissioners results in inequalities in access.
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12
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Tosh J, Brazier J, Evans P, Longworth L. A review of generic preference-based measures of health-related quality of life in visual disorders. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:118-27. [PMID: 22264979 PMCID: PMC3268858 DOI: 10.1016/j.jval.2011.08.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 07/29/2011] [Accepted: 08/02/2011] [Indexed: 05/02/2023]
Abstract
OBJECTIVE This review examines generic preference-based measures and their ability to reflect health-related quality of life in patients with visual disorders. METHODS A systematic search was undertaken to identify clinical studies of patients with visual disorders where health state utility values were measured and reported. Data were extracted to assess the validity and responsiveness of the measures. A narrative synthesis of the data was undertaken due to the heterogeneity between different studies. RESULTS There was considerable heterogeneity in the 31 studies identified in terms of patient characteristics, visual disorders, and outcomes reported. Vision loss was associated with a reduction in scores across the preference-based measure, but the evidence on validity and responsiveness was mixed. The EQ-5D health-related assessment instrument's performance differed according to condition, with poor performance in age-related macular degeneration (AMD) and diabetic retinopathy. The more limited evidence on the HUI-3 instrument found it performed best in differentiating between severity groups of patients with glaucoma, AMD, cataracts, and diabetic retinopathy. One study reported data on the SF-6D instrument and showed it was able to differentiate between patients with AMD. CONCLUSIONS The performance of the EQ-5D in visual disorders was mixed. The HUI-3 seemed to perform better in some conditions, but the evidence on this and SF-6D is limited. More head to head comparisons of these three measures are required. The new five-level version of EQ-5D may do better at the milder end of visual function.
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Affiliation(s)
- Jonathan Tosh
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK.
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Las Hayas C, Quintana JM, Espallargues M, Vrotsou K, Allepuz A, Escobar A, Moharra M. Potential for 2 priority systems to be used as appropriateness of indication tools for cataract surgery. CANADIAN JOURNAL OF OPHTHALMOLOGY 2010; 45:e1-7. [PMID: 20383913 DOI: 10.3129/i09-275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To test 2 systems developed to prioritize patients on waiting lists for cataract surgery, the Western Canadian Waiting List (WCWL), and the Catalan Agency for Health Technology Assessment and Research Cataract Priority System (CCPS), as tools for judging the appropriateness of the intervention. DESIGN Cross-sectional study with follow-up. PARTICIPANTS A total of 1723 prospective patients awaiting cataract extraction in 5 hospitals were included in the study. METHODS Priority scores using the WCWL and the CCPS systems were calculated and compared with visual acuity (VA) and visual function, measured by the Visual Function-14 index, before and after surgery. The sensitivity of each priority system to different groups was evaluated using a validated appropriateness of indications tool for cataract extraction. One-way analysis of variance and the Jonckheere-Terpstra test were used to detect differences in group scores. Spearman correlation coefficients were also examined. RESULTS The WCWL and CCPS systems produced different mean values according to the preoperative levels of VA and visual function (p < 0.0001). Neither system showed a significant difference in mean scores based on gains in VA and visual function. Both systems produced different mean scores according to the different groups of appropriateness set by the appropriateness of indications tool for cataract (p < 0.0001). CONCLUSIONS Given that appropriateness tools should correlate with outcomes, we recommend using neither the WCWL nor the CCPS for appropriateness purposes. Incorporating new criteria into these systems may improve the correlation with important outcomes and their adequacy for use as appropriateness tools.
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Affiliation(s)
- Carlota Las Hayas
- CIBER in Epidemiology and Public Health, Research Unit, Hospital Galdakao Usansolo, Vizcaya, Spain.
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Curtis AJ, Russell COH, Stoelwinder JU, McNeil JJ. Waiting lists and elective surgery: ordering the queue. Med J Aust 2010; 192:217-20. [DOI: 10.5694/j.1326-5377.2010.tb03482.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 10/07/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Andrea J Curtis
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Colin O H Russell
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
- Department of Surgery, Monash University, Melbourne, VIC
| | | | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
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Las Hayas C, González N, Aguirre U, Blasco JA, Elizalde B, Perea E, Escobar A, Navarro G, Castells X, Quintana JM. Can an appropriateness evaluation tool be used to prioritize patients on a waiting list for cataract extraction? Health Policy 2009; 95:194-203. [PMID: 20031251 DOI: 10.1016/j.healthpol.2009.11.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 11/23/2009] [Accepted: 11/25/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine whether a system originally developed to ascertain the appropriateness of cataract intervention may also be used to prioritize patients on cataract extraction waiting lists. METHODS The IRYSS-appropriateness of indication for cataract surgery tool and the IRYSS-Cataract Priority Score were applied to a sample of 5448 patients consecutively placed on waiting lists for cataract surgery. Clinical data were gathered by ophthalmologists, and patients self-completed the Visual Function Index-14. The general linear model (GLM) was used to assign scores to the categories of the appropriateness and priority criteria. The relationship between both systems was evaluated by correlating scores. To assess the validity of the new appropriateness and priority scores, correlations with visual acuity (VA) and visual function were calculated. RESULTS The GLM method generated highly similar scores for both appropriateness and prioritization systems. The correlation between scores was very strong (r=0.96). The appropriateness scoring system correlated 0.29 with VA and 0.21 with gain in visual function. The priority system correlated -0.54 with VA and -0.28 with preintervention visual function. CONCLUSIONS The new appropriateness scoring system strongly correlates with the priority scoring system. This easy-to-use appropriateness rating could serve as a tool for simultaneously assessing the appropriateness of cataract surgery and assigning priority.
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Affiliation(s)
- Carlota Las Hayas
- Unidad de Investigación, Hospital Galdakao-Usansolo Galdakao, Bizkaia, Spain.
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Gutiérrez SG, Quintana JM, Bilbao A, Escobar A, Milla EP, Elizalde B, Baré M, Fernandez de Larrea N. Validation of priority criteria for cataract extraction. J Eval Clin Pract 2009; 15:675-84. [PMID: 19674219 DOI: 10.1111/j.1365-2753.2008.01083.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Given the increasing prevalence of cataract and demand for cataract extraction surgery, patients must often wait to undergo this procedure. We validated a previously developed priority scoring system in terms of clinical variables, pre-intervention health status, appropriateness of surgery and gain in visual acuity (VA) and health-related quality of life (HRQoL). METHODS Explicit prioritization criteria for cataract extraction created by a variation of the Research and Development (RAND) and University of California Los Angeles appropriateness methodology were retrospectively applied to a prospective cohort of 5257 patients on waiting lists to undergo cataract by phacoemulsification at 17 hospitals in Spain. Demographic data, clinical data and data related to surgical technique were collected by trained ophthalmologists. Patients were evaluated by their ophthalmologist before the intervention and 6 weeks afterward. They also completed, by mail, the Visual Function Index (VF-14) before the intervention and 3 months afterward. RESULTS High-priority patients experienced greater improvement in VA and HRQoL than those classified as intermediate or low-priority (P < 0.0001), even after adjusting by VA and the VF-14 score at baseline. The time to intervention was the same for high-priority patients as it was for intermediate and low-priority patients. CONCLUSIONS The priority score we developed identified patients most likely to experience the greatest improvements from cataract extraction. Use of this tool could provide a fairer and more rational way to prioritize patients for cataract extraction.
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Affiliation(s)
- Susana García Gutiérrez
- Research Unit, Unidad de Investigación, Hospital Galdakao-Usansolo-CIBER Epidemiología y Salud Pública (CIBERESP), Galdakao, Bizkaia, Spain.
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Escobar A, González M, Quintana JM, Bilbao A, Ibañez B. Validation of a prioritization tool for patients on the waiting list for total hip and knee replacements. J Eval Clin Pract 2009; 15:97-102. [PMID: 19239588 DOI: 10.1111/j.1365-2753.2008.00961.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RATIONALE AND AIMS Total hip and knee replacements, usually, have long waiting lists. There are several prioritization tools for these kind of patients. A new tool should undergo a standardized validation process. The aim of the present study was to validate a new prioritization tool for primary hip and knee replacements. METHODS We carried out a prospective study. Consecutive patients placed on the waiting list were eligible for the study. Patients included were mailed a questionnaire which included, among other questions, the seven items of the priority tool and the Western Ontario and McMasters Universities Arthritis Index (WOMAC) specific questionnaire. The priority tool gives a score from 0 to 100 points, and three categories (urgent, preferent and ordinary). We studied the content and construct validity. We used Student's t-test or one-way analysis of variance. Correlational analysis was used to evaluate convergent and discriminate validity. RESULTS The sample consisted of 838 patients (62.3% were female), with mean age of 70.2 years (SD 8.4). A total of 55.5% patients underwent knee replacement. Given that the tool was elaborated by patients and orthopaedic surgeons, it shows a good content validity. The priority score was statistically different (P < 0.001) among the three urgency categories created. The scores of the three WOMAC dimensions showed differences (P < 0.001) by the three urgency categories created. The correlations between the priority score and WOMAC dimensions were 0.79 (function), 0.69 (pain) and 0.51 (stiffness). The correlations between WOMAC items and items from priority tool were greater (0.47-0.69) between items measuring similar constructs than those measuring different constructs (0.27-0.49). These data are similar in both joints. CONCLUSIONS Results support the validity of the prioritization tool to be used with patients waiting for hip or knee replacement.
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Canadian Ophthalmological Society evidence-based clinical practice guidelines for cataract surgery in the adult eye. CANADIAN JOURNAL OF OPHTHALMOLOGY 2008. [DOI: 10.3129/i08-133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Guide de pratique clinique factuelle de la Société canadienne d’ophtalmologie pour la chirurgie de la cataracte de l’œil adulte. CANADIAN JOURNAL OF OPHTHALMOLOGY 2008. [DOI: 10.1016/s0008-4182(08)80002-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Allepuz A, Espallargues M, Moharra M, Comas M, Pons JMV. Prioritisation of patients on waiting lists for hip and knee arthroplasties and cataract surgery: Instruments validation. BMC Health Serv Res 2008; 8:76. [PMID: 18397519 PMCID: PMC2373288 DOI: 10.1186/1472-6963-8-76] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 04/08/2008] [Indexed: 11/22/2022] Open
Abstract
Background Prioritisation instruments were developed for patients on waiting list for hip and knee arthroplasties (AI) and cataract surgery (CI). The aim of the study was to assess their convergent and discriminant validity and inter-observer reliability. Methods Multicentre validation study which included orthopaedic surgeons and ophthalmologists from 10 hospitals. Participating doctors were asked to include all eligible patients placed in the waiting list for the procedures under study during the medical visit. Doctors assessed patients' priority through a visual analogue scale (VAS) and administered the prioritisation instrument. Information on socio-demographic data and health-related quality of life (HRQOL) (HUI3, EQ-5D, WOMAC and VF-14) was obtained through a telephone interview with patients. The correlation coefficients between the prioritisation instrument score and VAS and HRQOL were calculated. For the reliability study a self-administered questionnaire, which included hypothetic patients' scenarios, was sent via postal mail to the doctors. The priority of these scenarios was assessed through the prioritisation instrument. The intraclass correlation coefficient (ICC) between doctors was calculated. Results Correlations with VAS were strong for the AI (0.64, CI95%: 0.59–0.68) and for the CI (0.65, CI95%: 0.62–0.69), and moderate between the WOMAC and the AI (0.39, CI95%: 0.33–0.45) and the VF-14 and the CI (0.38, IC95%: 0.33–0.43). The results of the discriminant analysis were in general as expected. Inter-observer reliability was 0.79 (CI95%: 0.64–0.94) for the AI, and 0.79 (CI95%: 0.63–0.95) for the CI. Conclusion The results show acceptable validity and reliability of the prioritisation instruments in establishing priority for surgery.
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Affiliation(s)
- Alejandro Allepuz
- Quality in Health Care Area, Catalan Agency for Health Technology Assessment and Research, Carrer de Roc Boronat, 81-95 (segona planta) 08005, Barcelona, Spain.
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Braybrooke J, Ahn H, Gallant A, Ford M, Bronstein Y, Finkelstein J, Yee A. The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16:1832-9. [PMID: 17701060 PMCID: PMC2223329 DOI: 10.1007/s00586-007-0452-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 05/31/2007] [Accepted: 07/14/2007] [Indexed: 10/23/2022]
Abstract
A prospective observational study was conducted on patients undergoing posterior lumbar spine surgery for degenerative spinal disorders. The study purpose was to evaluate the effect of wait time to surgery on patient derived generic and disease specific functional outcome following surgery. A prolonged wait to surgery may adversely affect surgical outcome. Although there is literature on the effect of wait time to surgery in surgical fields such as oncology, cardiac, opthamologic, and total joint arthroplasty, little is known regarding the effect of wait time to surgery as it pertains to the spinal surgical population. Consecutive patients undergoing elective posterior lumbar spinal surgery for degenerative disorders were recruited. Short-Form 36 and Oswestry disability questionnaires were administered (pre-operatively, and at 6 weeks, 6 months, and 1 year post-operatively). Patients completed a questionnaire regarding their experience with the wait time to surgery. The study cohort consisted of 70 patients with follow-up in 53/70 (76%). Time intervals from the onset of patient symptoms to initial consultation by family physician through investigations, spinal surgical consultation and surgery were quantified. Time intervals were compared to patient specific improvements in reported outcome following surgery using Cox Regression analysis. The effect of patient and surgical parameters on wait time was evaluated using the median time as a reference for those patients who had either a longer or shorter wait. Significant improvements in patient derived outcome were observed comparing post-operative to pre-operative baseline scores. The greatest improvements were observed in aspects relating to physical function and pain. A longer wait to surgery was associated with less improvement in outcome following surgery (SF-36 domains of BP, GH, RP, VT). A longer wait time to surgery negatively influences the results of posterior lumbar spinal surgery for degenerative conditions as quantified by patient derived functional outcome measures. The parameters of pain severity and physical aspects of function appear to be the most significantly affected.
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Affiliation(s)
- Jason Braybrooke
- Sunnybrook Spine Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre and Department of Surgery, University of Toronto, 2075 Bayview Avenue, Room MG 371-B, M4N 3M5 Toronto, ON Canada
- Orthopaedic and Trauma Department, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | - Henry Ahn
- Division of Orthopaedic Surgery, St. Michael’s Hospital and Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Aimee Gallant
- Sunnybrook Spine Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre and Department of Surgery, University of Toronto, 2075 Bayview Avenue, Room MG 371-B, M4N 3M5 Toronto, ON Canada
| | - Michael Ford
- Sunnybrook Spine Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre and Department of Surgery, University of Toronto, 2075 Bayview Avenue, Room MG 371-B, M4N 3M5 Toronto, ON Canada
| | - Yigel Bronstein
- Sunnybrook Spine Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre and Department of Surgery, University of Toronto, 2075 Bayview Avenue, Room MG 371-B, M4N 3M5 Toronto, ON Canada
| | - Joel Finkelstein
- Sunnybrook Spine Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre and Department of Surgery, University of Toronto, 2075 Bayview Avenue, Room MG 371-B, M4N 3M5 Toronto, ON Canada
| | - Albert Yee
- Sunnybrook Spine Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre and Department of Surgery, University of Toronto, 2075 Bayview Avenue, Room MG 371-B, M4N 3M5 Toronto, ON Canada
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Hodge W, Horsley T, Albiani D, Baryla J, Belliveau M, Buhrmann R, O'Connor M, Blair J, Lowcock E. The consequences of waiting for cataract surgery: a systematic review. CMAJ 2007; 176:1285-90. [PMID: 17452662 PMCID: PMC1852875 DOI: 10.1503/cmaj.060962] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cataract surgery is the most common operative procedure performed in Canada, and how patients are affected by wait times for this surgery has important clinical, public health and health policy considerations. We conducted a systematic review to understand the relation between wait time for cataract surgery and patient outcomes and the variables that modify this relation. METHODS We performed an electronic search of 11 databases and the proceedings of 4 conferences. The search was restricted to studies published after the transition to phacoemulsification (1990). We assessed the quality of the included studies using the Jadad Scale for randomized controlled trials and the Newcastle-Ottawa Scale for cohort and case-control studies. The data were found to be inappropriate for meta-analysis, thus we performed a qualitative synthesis. RESULTS We found a total of 27 studies that met our inclusion criteria. When these studies were reviewed, a dichotomy was observed for the wait time-outcome relation: outcomes associated with wait times of <or= 6 weeks were better than outcomes associated with wait times of >or= 6 months. Patients who waited more than 6 months to receive cataract surgery experienced more vision loss, a reduced quality of life and had an increased rate of falls compared with patients who had wait times of less than 6 weeks. The outcomes associated with wait times between 6 weeks and 6 months remain unclear. INTERPRETATION Patients who wait more than 6 months for cataract surgery may experience negative outcomes during the wait period, including vision loss, a reduced quality of life and an increased rate of falls.
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Affiliation(s)
- William Hodge
- Department of Ophthalmology, University of Ottawa Eye Institute, Ottawa, Ont.
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Lundström M, Albrecht S, Håkansson I, Lorefors R, Ohlsson S, Polland W, Schmid A, Svensson G, Wendel E. NIKE: a new clinical tool for establishing levels of indications for cataract surgery. ACTA ACUST UNITED AC 2006; 84:495-501. [PMID: 16879570 DOI: 10.1111/j.1600-0420.2006.00707.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool. METHODS Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called 'NIKE' (Nationell Indikationsmodell för Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day-to-day life, cataract symptoms, the ability to live independently, and medical/ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting. RESULTS Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test-retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively). CONCLUSIONS A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day-to-day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners.
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