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Quality Assurance in Ophthalmic Service Monitoring Cataract Surgery Outcome

Quality Assurance in Ophthalmic Service Monitoring Cataract Surgery Outcome. Dr. Goh Pik Pin Consultant Ophthalmologist Selayang Hospital. Introduction Why monitor treatment outcome?. Patient satisfaction -standard of treatment Self-audit – continuous professional development

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Quality Assurance in Ophthalmic Service Monitoring Cataract Surgery Outcome

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  1. Quality Assurance in Ophthalmic Service Monitoring Cataract Surgery Outcome Dr. Goh Pik Pin Consultant Ophthalmologist Selayang Hospital Health outcome conference July 2004

  2. Introduction Why monitor treatment outcome? • Patient satisfaction -standard of treatment • Self-audit – continuous professional development • Set standard or norm- monitor service performance • Practice of medicine - competent, accountable and ethical Health outcome conference July 2004

  3. How? Current methods of quality assurance : • Legislation- hospital licensing law 2. Professional self-regulation - specialty board 3. Informal peer review- census, log book 4. Formal accreditation and credentialing Health outcome conference July 2004

  4. Limitations • Subjective- e.g. inspection by external reviewer • Arbitrary- e.g. must have performed minimum x number of procedures before credentialing,  competence • No explicit reference to agreed standard Health outcome conference July 2004

  5. More Objective & Better Methods • Bench marking • Continuous quality monitoring • Statistical process control (SPC) technique – trend of performance e.g. Cumulative Sum (CUSUM) Health outcome conference July 2004

  6. Cataract Surgery OutcomeWhat do we measure? • Best Corrected Visual Acuity • Snellen, LogMar • Visual Function • Glare disability, contrast sensitivity • Quality of Life • VF 14, Vision Related Sickness Impact Profile, Catquest (Sweden), etc Health outcome conference July 2004

  7. Cataract Surgery OutcomeMethods • Population Based Survey • Rapid assessment on cataract surgery service -WHO • India, China, Nepal, Australia • Centre / Providers Based Studies • International Cat. Surgery Outcome Study- USA ,Canada, Denmark, Spain • European Cataract Outcome Group-1998 • USA- Medicare beneficiaries, NEON, PORT • UK-National Cataract Surgery Survey-1997 • Sweden-National Swedish Cataract Register-1992 • Malaysia-MOH Census & National Cataract Surgery Registry • Individual surgeon • Surgical log books • Statistical Processes Control – Cumulative Sum (CUSUM) Health outcome conference July 2004

  8. Ministry Of Health Hospitals Annual Census- Cataract service • Quantity • Practice pattern- day care, Phaco/ECCE, IOL • Quality measurements • Waiting time • Ratio of cataract surgeon to patients • Post-op infective endophthalmitis • Unplanned return to operating theatre • 31 MOH Hospitals • Standard census format • Defined numerator and denominator Health outcome conference July 2004

  9. Rate of Post-Op Endophthalmitis Health outcome conference July 2004

  10. National Cataract Surgery Registry(NCSR, www.crc.gov.my/ncsr) • Establish –2002 • Prospective systematic data collection • 32 centers (MOH, army & universities hospitals, 1 private) • Data collection- integrated into daily work • Objectives: • to determine frequency of cataract surgery • to monitor outcome and factors influencing outcomes • to evaluate cataract surgery services Health outcome conference July 2004

  11. NCSRData collected • Patient characteristics • Age, gender, 1st eye, ocular & systemic co-morbidity, presenting vision • Practice Pattern • Day care, anaesthesia, operation, IOL, Viscoelastic • Outcome measurements • Intra-op & post-op complications • Post-op BCVA by 12 weeks • Factors contributing to poor visual outcome • QA indicators • Post-op infective endophthalmitis • Unplanned return to OT within 1 week Health outcome conference July 2004

  12. NSCRAnnual Report 2002 & 2003 Health outcome conference July 2004

  13. NCSRCataract Surgery Outcome Health outcome conference July 2004

  14. NCSRBest corrected vision  6/12 at 12 weeks post operation Health outcome conference July 2004

  15. Best Corrected Vision ( 6/12) – phacoemulsification,year 2002 Health outcome conference July 2004

  16. Cataract Surgery OutcomeInternational comparison * All patient (with & without ocular co-morbidity) Health outcome conference July 2004

  17. Statistical Process Control –Cumulative Sum (CUSUM) CUSUM chart • Graph representation of the trend in outcomes of consecutive procedures performed over time by same surgeon • Early detection of unacceptable rate of adverse outcome • Applications • Monitoring of trainees • Continuous surgical audit Health outcome conference July 2004

  18. What is CUSUM charting? Health outcome conference July 2004

  19. CUSUM Trainee Consultant Health outcome conference July 2004

  20. CUSUM Chart for ECCE (NCSR) Health outcome conference July 2004

  21. Conclusion Quality assurance in ophthalmic service • Mandatory • Continuous - trend • Sustainable - integrated into daily work process • Surgeons - appreciative self audit for continuous professional development • Providers - continuous quality monitoring • Confidentially and medico-legal implication - issues to be considered Health outcome conference July 2004

  22. Acknowledgement • Dr Mariam Ismail National Head of Ophthalmology Service, MOH Head, Ophthalmology Department,Hospital Selayang • D.Lim Teck Onn Head, Clinical Research Centre, MOH • Dr.G.Arumugam President,Ophthalmological Soicety • Singapore Society of Ophthalmology Health outcome conference July 2004

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