Subburaman Ganesh-Babu B, Hariharan Luxme, Ravilla Thulasiraj D, Ravilla Ravindran D, Kempen John H
Aravind Eye Care System, Madurai, Tamilnadu, India.
Ophthalmology, Children's Hospital of Los Angeles/ University of Southern California Keck School of Medicine, Los Angeles, California.
Am J Ophthalmol. 2015 Oct;160(4):619-27.e1. doi: 10.1016/j.ajo.2015.06.005. Epub 2015 Jun 19.
To analyze the experience of a large developing country tertiary ophthalmology system to identify generalizable information relevant for those planning similar centers elsewhere.
Retrospective utilization analysis.
A historical review of the development of the Aravind Eye Care system was undertaken to evaluate the services provided by various tertiary services of the system. Demand for services is inferred based on the utilization statistics described below and distance traveled by patients to obtain services.
Utilization of subspecialty services increased logarithmically for 17 years in all specialties. At all centers except one historically focused on glaucoma, retina services had the highest demand among subspecialty surgical services. The proportion of tertiary care patients among all new outpatients (39% in 2009 and 45% in 2013) and the proportion of specialty surgical and treatment procedures among all procedures (30% in 1997 and 49% 2013) increased over time. More patients traveled long distances (>100 kilometers) to receive specialty services than to receive cataract services (30% vs 23%).
These observations suggest that in regions where tertiary services are not widely available, (1) patients demand (travel further for) tertiary care more than general ophthalmology services; (2) demand for services can expand rapidly for many years; (3) tertiary care services tend to grow over time as a proportion of all services provided; and (4) retina services are the most highly demanded subspecialty surgical services. In such settings, it is likely that considerable latent demand exists; planned tertiary eye centers should anticipate sustained growth of tertiary services.
分析一个大型发展中国家三级眼科系统的经验，以确定对计划在其他地方建立类似中心的人有普遍参考价值的信息。
回顾性利用分析。
对阿拉文德眼科护理系统的发展进行历史回顾，以评估该系统各三级服务部门提供的服务。根据以下所述的利用统计数据以及患者为获得服务所行进的距离来推断服务需求。
17年来，所有专科的亚专科服务利用率呈对数增长。除了一个历史上专注于青光眼的中心外，在所有中心，视网膜服务在亚专科手术服务中需求最高。三级护理患者在所有新门诊患者中的比例（2009年为39%，2013年为45%）以及专科手术和治疗程序在所有程序中的比例（1997年为30%，2013年为49%）随时间增加。与接受白内障服务的患者相比，更多患者长途跋涉（>100公里）接受专科服务（30%对23%）。
这些观察结果表明，在三级服务不广泛可得的地区，（1）患者对三级护理的需求（前往更远的地方接受治疗）超过普通眼科服务；（2）多年来服务需求可迅速扩大；（3）随着时间推移，三级护理服务在所有提供的服务中所占比例往往会增加；（4）视网膜服务是需求最高的亚专科手术服务。在这种情况下，很可能存在大量潜在需求；规划中的三级眼科中心应预计到三级服务的持续增长。
