流动手术中心：改善医疗荒漠地区白内障医疗保健的可能解决方案。
Ambulatory surgery centers: possible solution to improve cataract healthcare in medical deserts.
机构信息
From the Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau (Bigoteau, Cook, Duroi, Pisella, Khanna), Regional Unit of Epidemiology (EpiDcliC), Service of Medical Information, Epidemiology and Medical Economy, Teaching Hospital of Tours, Medical School, University of Tours (Grammatico-Guillon), Tours; Department of Medical Information, Centre Hospitalier Jacques Coeur (Massot), and Department of Ophthalmology, Centre Hospitalier Jacques Coeur (Bigoteau, Baudet, Pichard, Slim), Bourges, France.
出版信息
J Cataract Refract Surg. 2021 Mar 1;47(3):352-357. doi: 10.1097/j.jcrs.0000000000000452.
PURPOSE
To investigate the epidemiological impact of an ambulatory cataract surgery center providing a fast-track procedure without anesthetic evaluation on the access to cataract healthcare.
SETTING
French nationwide study.
DESIGN
Retrospective cross-sectional study.
METHODS
The study included individuals undergoing cataract surgery from the French national administrative database of medical information. Data analyses focused on patients living in the Cher and neighboring areas. Epidemiological indicators of patient flow and healthcare efficiency were calculated. A medicoeconomic analysis was performed.
RESULTS
Between 2012 and 2018, activity increased by +50.2% (3665 to 5506) interventions in the Cher area compared with a national increase of +22.7% (720 351/884 254), while maintaining a constant ophthalmologist workforce. The leakage ratio decreased by 5.9 points (26.3% to 20.4%), whereas the attractiveness and self-sufficiency ratios increased by 2.3 (8.6% to 10.9%) and 8.6 (80.6% to 89.2%) points, respectively. The age- and sex-standardized rate of healthcare utilization for cataract surgery increased by 4.3 points (11.6 to 15.9 cataract surgeries per 1000 inhabitants), making the Cher the second best French area in 2018 for the rate of cataract surgery despite ranking 96th of 109 French areas for ophthalmologist density. The cost of the cataract removal procedure was 523.99€ (666.22€ in the conventional operating room).
CONCLUSIONS
An ambulatory cataract surgery center with a fast-track procedure could represent a solution in medical deserts to improve cataract healthcare without supplementary funding. Nonetheless, consulting activity should be optimized to detect eye disorders and schedule interventions.
目的
研究一家提供无麻醉评估的快速通道白内障手术中心对白内障医疗保健可及性的流行病学影响。
设置
法国全国性研究。
设计
回顾性横断面研究。
方法
本研究纳入了法国国家医疗信息管理数据库中接受白内障手术的个体。数据分析集中在居住在谢尔和周边地区的患者。计算了患者流量和医疗效率的流行病学指标。进行了医疗经济分析。
结果
2012 年至 2018 年，谢尔地区的手术活动增加了 50.2%（3665 例增加至 5506 例），而全国仅增加了 22.7%（720351 例增加至 884254 例），同时维持了眼科医生的劳动力数量不变。渗漏率下降了 5.9 个百分点（26.3%降至 20.4%），而吸引力和自给自足率分别上升了 2.3 个百分点（8.6%升至 10.9%）和 8.6 个百分点（80.6%升至 89.2%）。白内障手术的标准化年龄和性别调整后使用率增加了 4.3 个百分点（每 1000 名居民中有 11.6 至 15.9 例白内障手术），尽管谢尔地区的眼科医生密度在全国 109 个地区中排名第 96 位，但在 2018 年，谢尔地区仍是白内障手术率排名第二的法国地区。白内障切除手术的费用为 523.99 欧元（常规手术室为 666.22 欧元）。
结论
拥有快速通道手术的日间白内障手术中心可能是改善白内障医疗保健的解决方案，无需额外资金支持，在医疗资源匮乏地区尤其如此。然而，应该优化就诊活动，以发现眼部疾病并安排手术。
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