Yonsei Med J.  2009 Jun;50(3):368-374. 10.3349/ymj.2009.50.3.368.

Analysis of Rating Appropriateness and Patient Outcomes in Cataract Surgery

• Choi YJ
• Park EC

• KMID: 1758564
• DOI: http://doi.org/10.3349/ymj.2009.50.3.368

Abstract

PURPOSE: Using the RAND/UCLA methodology to create the appropriateness criteria, we assessed that the appropriate ratings in cataract surgery can be a better prognosis of outcomes in postoperative 12 months than uncertain or inappropriate ratings. In addition, we indentified the degree of the appropriate rating surgery associated with the outcome changes in postoperative 12 months.
MATERIALS AND METHODS
The patients in this study were followed up prospectively in preoperative and postoperative 12 months periods. The 20 ophthalmologists in 14 hospitals were asked to refer about 20 patients who were scheduled to undergo cataract surgery from March and June of 1997. A multiple regression analysis was used to identify the degree of the appropriate surgery associated with the changes of outcomes. The outcomes were designed as the clinical and functional outcomes (visual acuity, visual function, satisfaction with vision, and satisfaction with overall care).
RESULTS
The outcome changes of vision acuity (p < 0.001), vision function-14 (p < 0.001), and symptom score (p < 0.006) were significantly different between four appropriateness ratings (crucial, appropriate, uncertain, and inappropriate). There was a trend that the appropriate rating surgeries were related to the successful change of the vision function (2.29, p = 0.015) and satisfaction with vision (3.84, p = 0.014) in 12 month postoperative period.
CONCLUSION
The crucial or appropriate rating surgeries may indicate better outcomes than uncertain or inappropriate rating surgeries do. The appropriate rating surgeries were more closely related to functional outcome vision function, VF-14 and subjective outcome (satisfaction with vision) in postoperative 12 months than inappropriate rating surgeries.

Keyword

Appropriateness ratings; patient outcomes; cataract surgery

MeSH Terms

Adult
Aged
*Cataract Extraction
Decision Making
Female
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Postoperative Period
Questionnaires
Regression Analysis
Treatment Outcome
Visual Acuity

Reference

1. Tobacman JK, Lee P, Zimmerman B, Kolder H, Hilborne L, Brook R. Assessment of appropriateness of cataract surgery at ten academic medical centers in 1990. Ophthalmology. 1996. 103:207–215.

2. Steinberg EP, Tielsch JM, Schein OD, Javitt JC, Sharkey P, Cassard SD, et al. National study of cataract surgery outcomes. Variation in 4-month postoperative outcomes as reflected in multiple outcome measures. Ophthalmology. 1994. 101:1131–1140. discussion 1140-1.

3. Hilborne LH, Leape LL, Bernstein SJ, Park RE, Fiske ME, Kamberg CJ, et al. The appropriateness of use of percutaneous transluminal coronary angioplasty in New York State. JAMA. 1993. 269:761–765.

4. Lee PP, Kamberg CJ, Hilborne LH, Michael MR, Kahan JP, Park RE, et al. RAND, RAND/ AMCC Report JRA-06. Cataract surgery: A review of the literature regarding efficacy and risks. 1993. Santa Monica, CA:

5. Quintana JM, Escobar A, Arostegui I. Development of appropriateness explicit criteria for cataract extraction by phacoemulsification. BMC Health Serv Res. 2006. 6:23.

6. Park RE, Fink A, Brook RH, Chassion MR, Kahn KL, Merrick NJ, et al. Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health. 1986. 76:766–772.

7. Health Insurance Review Agency. The analysis of statistical pattern in the health insurance claims data. 2007. HIRA Pub.

8. American Academy of Ophthalmology. Preferred Practice Pattern: cataract in the adult eye. 2001. San Francisco, Calif: American Academy of Ophthalmology;8.

9. U.S. Department of Health and Human Services, Public Health Service, Agency for health Care Policy and Research. No. 94-0068. "AHCPR Fact Sheet". April 1994. 04. AHCPR Pub.

10. Tarlov AR, Ware JE Jr, Greenfield S, Nelson EC, Perrin E, Zubkoff M. The Medical Outcome study. An application of methods for monitoring the results of medical care. JAMA. 1989. 262:925–930.

11. Maklan CW, Greene R, Cummings MA. Methodological challenges and innovations in patient outcomes research. Med Care. 1994. 32:7 Suppl. JS13–JS21.

12. Anderson GF, Hall MA, Steinberg EP. Medical technology assessment and practice guidelines: their day in court. Am J Public Health. 1993. 83:1635–1639.

13. Choi YJ, Hong YJ, Kang HG. Appropriateness ratings in cataract surgery. Yonsei Med J. 2004. 45:396–405.

14. Choi YJ, Nam CM, Kwak MJ. Multiple imputation technique applied to appropriateness ratings in cataract surgery. Yonsei Med J. 2004. 45:829–837.

15. Steinberg EP, Tielsch JM, Schein OD, Javitt JC, Sharkey P, Cassard SD, et al. The VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol. 1994. 112:630–638.

16. Tobacman JK, Zimmerman B, Lee P, Hilborne L, Kolder H, Brook RH. Visual acuity following cataract surgeries in relation to preoperative appropriateness ratings. Med Decis Making. 2003. 23:122–130.

17. Applegate WB, Miller ST, Elam JT, Freeman JM, Wood TO, Gettlefinger TC. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients. JAMA. 1987. 257:1064–1066.

18. Westheimer G. Scaling of visual acuity measurements. Arch Ophthalmol. 1979. 97:327–330.

19. Wright CJ, Chambers GK, Robens-Paradise Y. Evaluation of indications for and outcomes of elective surgery. CMAJ. 2002. 167:461–466.

20. Hemingway H, Crook AM, Feder G, Banerjee S, Dawson JR, Magee P, et al. Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization. N Engl J Med. 2001. 344:645–654.

21. Schein OD, Steinberg EP, Cassard SD, Tielsch JM, Javitt JC, Sommer A. Predictors of outcome in patients who underwent cataract surgery. Ophthalmology. 1995. 102:817–823.

22. Chandrasekaran S, Wang JJ, Rochtchina E, Mitchell P. Change in health-related quality of life after cataract surgery in a population-based sample. Eye. 2008. 22:479–484.