School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australia.
Clin Exp Optom. 2024 Mar;107(2):196-203. doi: 10.1080/08164622.2023.2275748. Epub 2023 Nov 12.
Realistic benchmarks can serve as comparators for optometrists wishing to engage in clinical practice audits of their glaucoma care.
The iCareTrack study established the appropriateness of glaucoma care delivery through clinical record audits of Australian optometry practices. Benchmarks required for monitoring and improving glaucoma care delivery do not exist. This study developed realistic benchmarks for glaucoma care and then benchmarked the performance of practices from the iCareTrack study to establish aspects of care that warrant attention from quality improvement initiatives.
Benchmarks were developed from the pre-existing iCareTrack dataset using the Achievable Benchmarks of Care (ABC) method. The iCareTrack study had audited the appropriateness of glaucoma care delivery against 37 clinical indicators for 420 randomly sampled glaucoma patient records from 42 Australian optometry practices. The four-step ABC method calculates benchmarks based on the top 10% of best-performing practices adjusted for low patient encounter numbers. iCareTrack results were compared to the benchmarks to explore the distribution of practices that were at, above or below benchmark.
Benchmarks were developed for 34 of 37 iCareTrack indicators. For 26 (of 34) indicators, the benchmarks were at or above 90% appropriateness. The benchmarks for 14 (of 34) iCareTrack indicators were met by more than 80% of eligible practices, indicating excellent performance. Some aspects of glaucoma care such as peripheral anterior angle assessment, applanation tonometry, and visual field assessment appeared to be delivered sub-optimally by optometrists when compared to the benchmarks.
This study established benchmarks for glaucoma care delivery in optometry practices that reflect realistic and top achievable performance. The large number of indicators with benchmarks above 90% confirmed that glaucoma care can and should be delivered by optometrists at very high levels of appropriateness. Benchmarking identified pockets of sub-optimal performance that can now be targeted by quality improvement initiatives.
现实基准可作为希望对其青光眼护理进行临床实践审核的验光师的比较基准。
iCareTrack 研究通过对澳大利亚验光实践的临床记录审核，确定了青光眼护理的适宜性。不存在用于监测和改善青光眼护理的基准。本研究制定了现实的青光眼护理基准，然后对 iCareTrack 研究中的实践进行基准测试，以确定需要质量改进措施关注的护理方面。
使用 Achievable Benchmarks of Care（ABC）方法从现有的 iCareTrack 数据集中制定基准。iCareTrack 研究已根据 37 项临床指标对 420 名来自 42 家澳大利亚验光实践的随机抽样青光眼患者记录进行了青光眼护理的适宜性审核。ABC 四步计算法基于最佳表现实践的前 10%并根据低患者就诊次数进行调整，从而计算出基准。将 iCareTrack 结果与基准进行比较，以探讨符合基准或高于或低于基准的实践分布。
为 37 项 iCareTrack 指标中的 34 项制定了基准。对于 26 项（34 项中的 26 项）指标，基准的适宜性达到或高于 90%。14 项（34 项中的 14 项）iCareTrack 指标的基准符合 80%以上的合格实践，表明表现出色。与基准相比，青光眼护理的某些方面，例如周边前房角评估、压平眼压测量和视野评估，似乎由验光师提供的效果不理想。
本研究为验光实践中的青光眼护理制定了反映现实和最高可实现绩效的基准。基准超过 90%的指标数量众多，这证实了青光眼护理可以并且应该由验光师以非常高的适宜性水平提供。基准测试确定了现在可以通过质量改进措施关注的表现不佳的领域。
