Leshno M, Reuveni H
School of Business Administration, Hebrew University of Jerusalem, Kupat Holim Clalit, Israel.
Clin Perform Qual Health Care. 1999 Jan-Mar;7(1):23-7.
To assess and compare the appropriateness of cataract extraction in two Israeli regional hospitals.
Two Israeli hospitals located in different geographic areas.
A randomized sample of 150 patients was drawn from a list of all patients who underwent cataract surgery at the two study hospitals during 1995. Detailed extraction of hospital medical records was performed. The appropriateness of cataract surgery was assessed using the Medical Review System, an interactive expert system that assesses the appropriateness of selected medical and surgical procedures.
The rates of cataract surgery in the two hospitals were 0.54 and 0.59 operations per 1,000 population, respectively, and the age-adjusted rates per 1,000 population were 5.7 and 6.2, respectively. The percentage of patients with only light perception or hand-motion perception in the operated eye before the operation was 62.2%, with no difference in the two hospitals. There was not a significant difference in the distribution of visual acuity before the operation; however, there was a significant difference in the distribution of visual acuity after the surgery. Rates of inappropriate surgeries in the two hospitals were found to be similar to the inappropriate rate in the United States (1.3%). The preoperative visual acuity of patients undergoing cataract surgery in Israel was inferior to the visual acuity of patients undergoing cataract surgery in the United States.
To increase quality and cost-effectiveness in the Israeli medical system, future studies of this type are warranted in connection with surgical procedures.
评估并比较以色列两家地区医院白内障摘除术的合理性。
位于不同地理区域的两家以色列医院。
从1995年在两家研究医院接受白内障手术的所有患者名单中随机抽取150名患者。对医院病历进行详细提取。使用医学审查系统评估白内障手术的合理性，该系统是一个交互式专家系统，用于评估选定医疗和外科手术的合理性。
两家医院的白内障手术率分别为每1000人0.54例和0.59例，年龄调整后的每1000人手术率分别为5.7例和6.2例。术前患眼仅有光感或手动感的患者百分比为62.2%，两家医院无差异。术前视力分布无显著差异；然而，术后视力分布存在显著差异。发现两家医院不适当手术的发生率与美国的不适当率（1.3%）相似。以色列接受白内障手术患者的术前视力低于美国接受白内障手术患者的视力。
为提高以色列医疗系统的质量和成本效益，有必要针对手术程序开展此类进一步研究。
