Judson Katherine, Courtright Paul, Ravilla Thulsiraj, Khanna Rohit, Bassett Ken
Seva Foundation, 1786 5th St, Berkeley, CA, 94710, USA.
Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
BMC Ophthalmol. 2017 Jun 19;17(1):96. doi: 10.1186/s12886-017-0492-5.
This study measured the effectiveness and cost of a capacity building intervention in 25 eye hospitals in South Asia, East Africa and Latin America over 4 years. The intervention involved eye care non-governmental organizations or high-performing eye hospitals acting as "mentors" to underperforming eye hospitals- "mentees" in 10 countries. Intervention activities included systematic planning and support for training and key equipment purchases as well as hospital-specific mentoring which focused on strengthening leadership, increasing the volume and equity of community outreach, improving surgical quality and volume, strengthening organizational and financial management and streamlining operational processes.
This is a before and after observational study of the impact of this multi-dimensional process on hospital and individual productivity and financial sustainability after 4 years. Mentee hospitals reported data monthly using a standardized template. Key indicators included cataract surgery volume, cataract operations per surgeon, the proportion of direct paying cataract surgical patients, intervention program costs per additional surgery and cost per mentor.
By the end of the study period, the hospitals experienced a 69% average increase (range: -63% to 690%) in cataract surgical volume over baseline with 12 hospitals showing increases over 100%. Twenty-three hospitals experienced a 59% average increase in the number of cataract surgeries per surgeon with 10 hospitals showing increases over 100%. The proportion of paying patients increased in 8 of the 14 hospitals reporting this data. The average mentoring cost per additional surgery for these 25 hospitals was $5.39. An average of $36,489.99 was spent per mentor per year to support their work with mentees.
The intervention resulted in proportionally similar increases in cataract surgical volume and productivity across diverse settings in three distinct geographic regions. Its wide applicability and moderate cost make it an attractive means to rapidly and substantially increase eye care services to meet VISION2020 goals.
本研究评估了一项能力建设干预措施在4年时间里对南亚、东非和拉丁美洲25家眼科医院的效果及成本。该干预措施涉及眼科护理非政府组织或表现出色的眼科医院，它们在10个国家中作为“导师”指导表现欠佳的眼科医院（“学员”）。干预活动包括系统规划以及对培训和关键设备采购的支持，还有针对医院的个性化指导，重点在于加强领导力、增加社区外展服务的数量和公平性、提高手术质量和数量、加强组织和财务管理以及简化运营流程。
这是一项前后对照观察性研究，旨在评估这一多维过程在4年后对医院及个人生产力和财务可持续性的影响。学员医院每月使用标准化模板报告数据。关键指标包括白内障手术量、每位外科医生的白内障手术例数、直接付费白内障手术患者的比例、每增加一例手术的干预项目成本以及每位导师的成本。
在研究期结束时，这些医院的白内障手术量较基线水平平均增长了69%（范围：-63%至690%），其中12家医院的增幅超过100%。23家医院每位外科医生的白内障手术例数平均增长了59%，其中10家医院的增幅超过100%。在报告该数据的14家医院中，有8家医院付费患者的比例有所增加。这25家医院每增加一例手术的平均指导成本为5.39美元。每位导师每年平均花费36,489.99美元来支持他们对学员的指导工作。
该干预措施在三个不同地理区域的多样化环境中，使白内障手术量和生产力按比例实现了类似的增长。其广泛的适用性和适度的成本使其成为快速大幅增加眼科护理服务以实现“视觉2020”目标的有吸引力的手段。
