Tahhan Nina, Ford Belinda Kate, Angell Blake, Liew Gerald, Nazarian Joseph, Maberly Glen, Mitchell Paul, White Andrew J R, Keay Lisa
School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
Brien Holden Vision Institute, Sydney, New South Wales, Australia.
BMJ Open. 2020 Oct 5;10(10):e036842. doi: 10.1136/bmjopen-2020-036842.
To determine whether a collaborative model of care that uses task-sharing for the management of low-risk diabetic retinopathy, Community Eye Care (C-EYE-C), can improve access to care and better use resources, compared with hospital-based care.
Retrospective audit of medical and financial records to compare two models of care.
A large, urban tertiary Australian publicly funded hospital.
C-EYE-C is a collaborative care model, involving community-based optometrist assessment and 'virtual review' by ophthalmologists to manage low-risk patients. The C-EYE-C model of care was implemented from January to October 2017.
New low-risk patient referrals with diabetes received at a tertiary hospital ophthalmology unit.
Historical standard hospital care was compared with C-EYE-C for attendance, wait-times, outcomes and costs. Clinical concordance between the optometrist and ophthalmologist diagnosis and management was assessed using weighted kappa statistic.
There were 133 new low-risk referrals, managed in standard hospital care (n=68) and C-EYE-C (n=65). Attendance rates were similar between the models of care (72.1% hospital vs 67.7% C-EYE-C, p=0.71). C-EYE-C had shorter appointment wait-time (53 vs 118 days, p<0.01). In the C-EYE-C model of care, 68.2% of patients did not require hospital appointments and costs were 43% less than hospital care. There was substantial agreement between optometrists and ophthalmologists for diagnosis (κ=0.64, CI 0.47-0.81) and management (κ=0.66, CI 0.45-0.87).
This Australian study showed that collaborative eye care resulted in reduced patient waiting times and considerable cost-savings, while maintaining a high standard of patient care compared with traditional hospital-based care in the management of low-risk hospital referrals with diabetic eye disease. The improved access and reduced costs were largely the result of better task allocation through greater utilisation of primary eye care professionals to provide services for low-risk patients. Better resource use may free up further resources for other eye care services.
确定一种采用任务分担方式管理低风险糖尿病视网膜病变的协作式护理模式——社区眼保健（C-EYE-C），与基于医院的护理相比，是否能改善医疗服务的可及性并更好地利用资源。
对医疗和财务记录进行回顾性审计，以比较两种护理模式。
澳大利亚一家大型城市三级公立资助医院。
C-EYE-C是一种协作式护理模式，包括社区验光师评估以及眼科医生对低风险患者进行“虚拟复诊”。C-EYE-C护理模式于2017年1月至10月实施。
在一家三级医院眼科接收的新发低风险糖尿病患者转诊病例。
将传统的医院护理与C-EYE-C在就诊率、等待时间、结局和成本方面进行比较。使用加权kappa统计量评估验光师和眼科医生在诊断和管理方面的临床一致性。
共有133例新发低风险转诊病例，分别采用标准医院护理（n = 68）和C-EYE-C（n = 65）进行管理。两种护理模式的就诊率相似（医院护理为72.1%，C-EYE-C为67.7%，p = 0.71）。C-EYE-C的预约等待时间更短（53天对118天，p < 0.01）。在C-EYE-C护理模式中，68.2%的患者无需到医院就诊，成本比医院护理低43%。验光师和眼科医生在诊断（κ = 0.64，CI 0.47 - 0.81）和管理（κ = 0.66，CI 0.45 - 0.87）方面有高度一致性。
这项澳大利亚的研究表明，与传统的基于医院的护理相比，协作式眼保健在管理低风险糖尿病眼病医院转诊病例时，可减少患者等待时间并节省大量成本，同时保持高标准的患者护理。医疗服务可及性的改善和成本的降低主要是通过更多地利用初级眼保健专业人员为低风险患者提供服务，从而实现了更好的任务分配。更好地利用资源可能会为其他眼保健服务腾出更多资源。
