Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, Shaanxi Province, China.
Harvard Medical School, Harvard University, Boston, Massachusetts, USA.
Br J Ophthalmol. 2021 Mar;105(3):311-316. doi: 10.1136/bjophthalmol-2019-315103. Epub 2020 May 20.
BACKGROUND/AIMS: Few studies have objectively examined the quality of eye care in China. We assessed refractive care using the incognito standardised patient (SP) approach, a gold standard for evaluating clinical practice.
A total of 52 SPs were trained to provide standardised responses during eye examinations, and underwent automated and non-cycloplegic, subjective refraction by a senior ophthalmologist from Zhongshan Ophthalmologic Center, a national-level clinical and research centre. SPs subsequently received subjective refraction and eye exams at a randomly selected sample of 40 public hospitals and 93 private optical shops in Shaanxi, Northwestern China. Difference between expert and local refraction in the better-seeing eye was calculated by the vector diopteric method, and completeness of exams assessed against national standards. SP and provider demographic information and provider clinical experience were recorded.
SPs (n=52, mean (range) age, 25.7 (22-31) years, 28.8% male) underwent 133 eye exams (mean total duration 15.0±11.7 min) by 133 local refractionists (24-60 years, 30.3% male). Only 93 (69.9%), 121 (91.0%) and 104 (78.2%) of local refractionists assessed vision, automated and subjective refraction, respectively. The median inaccuracy was -0.25 diopters (D), while 25.6% of results differed by an absolute value of ≥1.0 D and 6.0% by ≥2.0 D. Predictors of inaccurate refraction included spectacle power <-6.0 D (OR=2.66; 95% CI, 1.27 to 5.56), service at a public (vs private) hospital (OR=2.01; 95% CI, 1.11 to 3.63) and provider male sex (OR=2.03; 95% CI, 1.11 to 3.69).
Inaccurate refractions are common in Northwestern China, particularly in public facilities. Important assessments, including subjective refraction, are frequently omitted.
背景/目的：很少有研究客观评估中国的眼科护理质量。我们使用隐形标准化患者（SP）方法评估屈光治疗，这是评估临床实践的金标准。
共培训 52 名 SP 提供标准的眼部检查反应，并由中山大学眼科中心的一名高级眼科医生进行自动和非睫状肌麻痹的主观屈光检查，该中心是国家级临床和研究中心。SP 随后在陕西的 40 家公立医院和 93 家私人眼镜店中随机选择样本接受主观屈光和眼部检查。通过矢量屈光度法计算最佳视力眼的专家和当地屈光度之间的差异，并根据国家标准评估检查的完整性。记录 SP 和提供者的人口统计学信息和提供者的临床经验。
SP（n=52，平均（范围）年龄 25.7（22-31）岁，28.8%为男性）接受了 133 次眼部检查（平均总时长 15.0±11.7 分钟）由 133 名当地验光师（24-60 岁，30.3%为男性）进行。只有 93（69.9%）、121（91.0%）和 104（78.2%）的当地验光师评估了视力、自动和主观屈光。中位数不准确为-0.25 屈光度（D），而 25.6%的结果绝对值差异≥1.0 D，6.0%的结果绝对值差异≥2.0 D。不准确屈光的预测因素包括眼镜度数<-6.0 D（OR=2.66；95%CI，1.27 至 5.56）、在公立医院（vs 私立医院）服务（OR=2.01；95%CI，1.11 至 3.63）和提供者为男性（OR=2.03；95%CI，1.11 至 3.69）。
在中国西北部，不准确的屈光很常见，尤其是在公共设施中。重要的评估，包括主观屈光检查，经常被遗漏。
