| | Regional Eye Clinics’ Glaucoma Outcome Study
Purpose
To assess Gundersen Lutheran Regional Eye Clinics’ care of patients with open angle glaucoma.
Background
Glaucoma is the second most common cause of blindness in the United States and the most common among African Americans. Glaucoma is a disease in which the internal pressure of the eye increases to damage the nerve fibers of the optic nerve and cause vision loss. The exact cause of primary open angle glaucoma, the most common form, is uncertain. While there is no “cure” for glaucoma, vision loss can usually be prevented or slowed if treatment is started early and internal eye pressures are controlled.
Two of the clinical hallmark tests to monitor glaucoma control and vision loss are visual field testing and intraocular pressure control. The American Academy of Ophthalmology (AAO) has established preferred practice patterns as guides to patient care (1).
Aims
1. All patients with glaucoma will have visual field evaluation at least every 24 months.
2. All patients with glaucoma will have optic nerve head evaluations every 6 to 18 months.
3. All patients with glaucoma will have IOP recorded at each visit.
Methods/Measures
Glaucoma patients at Gundersen Lutheran Regional Eye Clinics over a four-year period were identified by review of coding/billing data. Then patients were randomly selected for chart review and abstraction of data elements. In 2001-2002, 781 patients were identified as having a diagnosis of glaucoma at the 9 regional sites and 1423 patients with glaucoma were seen in 2003-2004 at 10 sites. Medical records were reviewed in order to determine compliance to guideline standards; presence or absence of a log sheet on the chart was recorded as well as documentation of target IOP. Twenty seven percent, 214 patients, were reviewed in the first study period and 270 in the second period.
Results
Conclusions:
1. There has been significant improvement (p<0.01) in documentation of all measures – visual fields, optic nerves, IOP at each visit and target IOP - between study periods. The aim of assessing intraocular pressures at every visit has been achieved.
2. Use of the flow sheet to document patient visits has increased significantly (p<0.01).
Next Steps:
1. Provide education regarding guidelines, stressing the importance of specific guidelines set forth by the AAO.
2. Encourage the use of the glaucoma log or flow sheet developed to improve documentation of necessary tests and recommended frequency.
3. Display site-specific data to all providers and give them an opportunity for discussion.
4. Develop a clinical practice guideline for glaucoma care and post to Gundersen Lutheran’s site on the clinical workstation
5. Continue to monitor performance and give feedback related to the guideline recommendations
Reference:
(1) American Academy of Ophthalmology Summary Benchmarks for Preferred Practice Patterns, June 2001. www.aao.org
Team Leader:
Andrew Nahas, O.D.
Acknowledgements:
Jane Robinson, RHIA, and Cheryl Strom, RN, Quality and Performance Improvement
Jeff Falk, MS, Quality and Performance Improvement
Michelle Mathiason, MS, Biostatistics
Karol Dowling, Regional Eye Clinic Manager |