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Sulonen S, Leinonen S, Lehtonen E, Hujanen P, Vaajanen A, Syvänen U, Hemelings R, Stalmans I, Tuulonen A, Uusitalo-Jarvinen H. A prototype protocol for evaluating the real-world data set using a structured electronic health record in glaucoma. Acta Ophthalmol 2024; 102:216-227. [PMID: 37753831 DOI: 10.1111/aos.15763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE As the first step in monitoring and evaluating day-to-day glaucoma care, this study reports all real-world data recorded during the first full year after the implementation of a prototype for glaucoma-specific structured electronic healthcare record (EHR). METHODS In 2019, 4618 patients visited Tays Medical Glaucoma Clinic at Tays Eye Centre, Tampere University Hospital, Finland, that serves a population of 0.53 M. Patient data were entered into a glaucoma-specific EHR by trained nurses to be checked by glaucoma specialists. Tays Eye Centre follows the Finnish Current Care Guideline for glaucoma in which glaucoma is defined using a '2 out of 3' rule, that is, ≥2 findings evaluated as glaucomatous in optic nerve head (ONH), retinal nerve fibre layer (RNFL) and visual field (VF). RESULTS The clinical evaluations of ONH, RNFL and VF were recorded in 95%-100% of all eyes. ONH was evaluated as glaucomatous more often (44%) than RNFL (33%) and VF tests (30%). Progressive changes in any of the three tests were recorded in 35% of the '≥2/3 glaucoma group' compared to 2%-9% in the other groups. The mean IOP at visit was 15 mmHg. The mean target IOP was 17 mmHg, and it was recorded in 94% of eyes. CONCLUSION The developed structured data presentation enables comparisons between different population-based real-world glaucoma data sets and glaucoma clinics. Compared to a data set from the UK, the proportion of glaucoma suspicion-related visits was smaller in Tays Eye Centre and test intervals were longer.
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Affiliation(s)
- Sakari Sulonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sanna Leinonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Eemil Lehtonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekko Hujanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Anu Vaajanen
- Eye and Vision Research SILK, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Syvänen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Ruben Hemelings
- Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Leuven, Belgium
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) programme, Singapore, Singapore
| | - Ingeborg Stalmans
- Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Leuven, Belgium
- Ophthalmology Department, UZ Leuven, Leuven, Belgium
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Hannele Uusitalo-Jarvinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
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Hujanen P, Vaajanen A, Felin T, Lehtonen E, Syvänen U, Huhtala H, Helminen M, Sintonen H, Tuulonen A, Uusitalo-Järvinen H. Immediate sequential bilateral cataract surgery: a 13-year real-life report of 56 700 cataract operations. Br J Ophthalmol 2023; 107:1782-1786. [PMID: 36229178 DOI: 10.1136/bjo-2021-320588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To assess the frequency of immediate sequential bilateral cataract surgery (ISBCS) and endophthalmitis during 13-year period in Tays Eye Centre, Tampere University Hospital, Tampere, Finland. METHODS All cataract surgeries performed between 1 January 2008 and 31 December 2020, and all endophthalmitis cases during the same period were searched from electronic patient records. Numbers and frequencies of ISBCS, and complications, including endophthalmitis and vitreous loss, were recorded and compared with unilateral operations. RESULTS The study included 56 700 cataract surgeries in 34 797 patients of whom 39% (n=13 445) had ISBCS. The median age of the patients was 75 (IQR 68-80, range 0.08-99) years at the time of surgery. The proportion of ISBCS patients increased from 4.2% in 2008 to 46% in 2020. Vitreous loss occurred in 480 (0.9%) of cataract surgeries. There were no postoperative endophthalmitis after cataract surgery (n=0) during the 13-year period. CONCLUSION The proportion of patients undergoing ISBCS increased from 4.2% in 2008 to 46% in 2020. No endophthalmitis were found to be associated with ISBCS.
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Affiliation(s)
- Pekko Hujanen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anu Vaajanen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tuukka Felin
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eemil Lehtonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Syvänen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mika Helminen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Hannele Uusitalo-Järvinen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Hujanen P, Ruha H, Lehtonen E, Pirinen I, Huhtala H, Vaajanen A, Syvänen U, Tuulonen A, Uusitalo-Järvinen H. Ten-year real-world outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration using pro re nata regimen. BMJ Open Ophthalmol 2023; 8:e001328. [PMID: 37586826 PMCID: PMC10432647 DOI: 10.1136/bmjophth-2023-001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND/AIMS To analyse long-term outcomes of antivascular endothelial growth factor (anti-VEGF) therapy for the treatment of neovascular age-related macular degeneration (nAMD) using pro re nata (PRN) regimen in a single-centre clinical practice. METHODS All patients receiving intravitreal injection (IVI) for nAMD between 1 January 2008 and 31 December 2020 were searched from electronic medical records. All 3844 treatment-naïve eyes of 3008 patients were included with a total of 50 146 IVIs (87% bevacizumab) administered. Main outcome measures were mean change in visual acuity (VA) from baseline, proportion of eyes within 15 letters of baseline, proportion of eyes with VA ≥20/40 Snellen and ≤20/200 Snellen, number of annual visits and number of annual IVIs. RESULTS The mean baseline VA was 55 Early Treatment Diabetic Retinopathy Study (ETDRS) letters and the mean change in VA from baseline was +2, +2, ±0, -2, -2 and -4 ETDRS letters at year 1, 2, 3, 5, 7 and 10, respectively. Proportions of eyes within 15 letters of baseline were 88%, 87%, 82%, 80%, 76% and 72% at the end of years 1, 2, 3, 5, 7 and 10, respectively. The median number of annual IVI was 6 at years 1-7 and 5 at year 10. The median number of annual total visits was 10 at year 1, 9 at years 2-7 and 8 at year 10, respectively. CONCLUSIONS VA was maintained short-term and long-term with anti-VEGF therapy using PRN treatment regimen.
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Affiliation(s)
- Pekko Hujanen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heikki Ruha
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eemil Lehtonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Inka Pirinen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anu Vaajanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Syvänen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Hannele Uusitalo-Järvinen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Tuulonen A, Kataja M, Syvänen U, Miettunen S, Uusitalo H. Right services to right patients at right time in right setting in Tays Eye Centre. Acta Ophthalmol 2016; 94:730-735. [PMID: 27422769 DOI: 10.1111/aos.13168] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The report describes the concepts behind procedures implemented in Tays Eye Centre to enable improved access to care and improved productivity. METHODS The strategy was developed in 2009 after hospital district decided to construct a new eye hospital which was opened in 2012. The following principles were implemented: (i) identification of high-volume patient groups: the 'big four' eye diseases accounting for 70% of patient visits and costs: age-related macular degeneration (AMD), glaucoma, retinal diseases and cataract; (ii) stratification and prioritization of patient care based on risk of permanent visual disability; (iii) standardization of services for low-risk patients; (iv) maximization of productivity; and (v) shared care. The impact of the new strategy on access to care and productivity is reported for years 2011-2015. RESULTS In 2011-2015, the total number of services provided increased 46% while the work contribution increased 15%. The number of referrals increased 76% and the number of outpatient appointments increased 2.5-fold. Simultaneously, the number of delayed follow-up visits decreased to zero. Age-related macular degeneration (AMD) injections increased 1.8-fold. However, after 50% yearly increase in Age-related macular degeneration (AMD) injections, a plateau was reached in 2014 with a 3% decline in 2014-2015 with no changes in treatment indications. In the beginning of 2016, the number of injections has started to increase again (+9% compared to 2015). The total number of surgical procedures increased 98%. The annual number of cataract surgeries increased 64% and bilateral surgeries from 11% to 39%. CONCLUSION Revised operational concepts and new facilities together with a 15% increase in work contribution led to a 46% increase in overall productivity, improved access to care and the clearance of delayed services. Efforts continue to further refine cost-effective care and to define the appropriate levels of services.
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Affiliation(s)
- Anja Tuulonen
- Tays Eye Centre; Tampere University Hospital; Tampere Finland
| | - Marko Kataja
- Tays Eye Centre; Tampere University Hospital; Tampere Finland
| | - Ulla Syvänen
- Tays Eye Centre; Tampere University Hospital; Tampere Finland
| | - Sirpa Miettunen
- Tays Eye Centre; Tampere University Hospital; Tampere Finland
| | - Hannu Uusitalo
- Tays Eye Centre; Tampere University Hospital; Tampere Finland
- Research and Development Centre for Ophthalmic Innovations (SILK); Department of Ophthalmology; University of Tampere; Tampere Finland
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