Lundström Mats, Stenevi Ulf
Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden.
Optom Vis Sci. 2013 Aug;90(8):754-9. doi: 10.1097/OPX.0b013e3182956c32.
The purpose of this study was to analyze three models of how patient-reported outcome measures can be connected to clinical outcome measures in cataract surgery to identify opportunities for improvement of quality of care.
Three models were used to analyze the following questions: Is there a relationship between clinical parameters and patient-reported outcomes? (1) Is there a relationship between clinical parameters and a good or poor patient-reported outcome? (2) When and why do clinical and patient-reported outcomes diverge? (3) The study material to exemplify these models consisted of follow-up data on cataract extractions collected by the Swedish National Cataract Register in 2008 to 2011. Patient-reported outcome was measured using the Catquest-9SF questionnaire. A total of 9707 pairs of questionnaires completed before and after a cataract extraction were analyzed together with clinical data.
Factors related to any change in patient-reported outcomes after surgery were the preoperative self-assessed visual function, the preoperative visual acuity in both eyes, the postoperative visual acuity, and ocular comorbidity. Factors related to poor patient-reported outcomes after surgery were good preoperative self-assessed visual functions, poor preoperative visual acuity in the better eye, ocular comorbidity, surgical complications, and large refractive deviation. Poor near vision after surgery was the main factor noted in situations where the clinical outcome was good and the patient-reported outcome was poor. Analyses 2 and 3 were the most useful analyses to give ideas for clinical improvement work.
The best models to give ideas for improved quality of care by using a patient questionnaire in our study were analyzing the risk factors for a poor patient-reported outcome and analyzing the factors associated with disagreement between clinical outcomes and patient-reported outcomes.
本研究旨在分析三种将患者报告的结局指标与白内障手术临床结局指标相联系的模型，以确定改善医疗质量的机会。
使用三种模型分析以下问题：临床参数与患者报告的结局之间是否存在关联？（1）临床参数与良好或不良的患者报告结局之间是否存在关联？（2）临床和患者报告的结局何时以及为何会出现差异？（3）用于例证这些模型的研究材料包括瑞典国家白内障登记处2008年至2011年收集的白内障摘除术随访数据。使用Catquest-9SF问卷测量患者报告的结局。总共9707对白内障摘除术前和术后完成的问卷与临床数据一起进行了分析。
与术后患者报告结局的任何变化相关的因素包括术前自我评估的视觉功能、双眼术前视力、术后视力和眼部合并症。与术后不良患者报告结局相关的因素包括良好的术前自我评估视觉功能、较好眼术前视力差、眼部合并症、手术并发症和较大的屈光偏差。术后近视力差是临床结局良好而患者报告结局较差的情况下最主要的因素。分析2和3对于为临床改进工作提供思路最为有用。
在我们的研究中，通过使用患者问卷为改善医疗质量提供思路的最佳模型是分析不良患者报告结局的危险因素以及分析与临床结局和患者报告结局之间不一致相关的因素。
