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Interhospital variation in appropriateness of cataract surgery
Author(s) -
Llorente César,
Blasco Juan A.,
Quintana José M.,
Bilbao Amaia,
Alberdi Txomin,
Lacalle Juan R.,
Begiristain José M.,
Baré Marisa
Publication year - 2011
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2010.01421.x
Subject(s) - phacoemulsification , medicine , observational study , logistic regression , cataract surgery , univariate , univariate analysis , appropriateness criteria , multivariate analysis , emergency medicine , multivariate statistics , visual acuity , optometry , ophthalmology , statistics , mathematics , radiology
Objective The aim of this study was to analyse the inter‐hospital variation in the appropriateness of cataract phacoemulsification in Spain. Methods This observational, multicentre, prospective study involved patients aged 18–90 years. Each phacoemulsification intervention was classified as ‘necessary’, ‘appropriate’, ‘uncertain’ or ‘inappropriate’ according to explicit appropriateness criteria previously established using the RAND/UCLA methodology. A descriptive statistical analysis was performed, followed by univariate and multivariate logistic regression analysis, in order to examine the differences between hospitals. Results In total, 5063 patients from 15 hospitals were enrolled. The percentage of patients in each hospital who inappropriately underwent phacoemulsification varied from 1.2% to 24.0% ( P < 0.0001). The most common inappropriate scenario was that of patients with a simple, unilateral cataract with no limitation of their visual function, with a pre‐surgery visual acuity of ≥0.5 in both eyes, and for whom surgical correction would involve low technical complexity. Conclusions The variation in appropriateness of phacoemulsification cannot be attributed solely to the clinical differences between the hospitals' patients. There is room for improvement in the appropriate indication of phacoemulsification. Measures based on the dissemination of appropriateness criteria might improve quality of care.