Variations in Cataract Management: Patient and Economic Outcomes. Final Report ofthe Patient Outcome Research Team (PORT)

摘要

Cataract surgery is the most common surgical procedure performed on Medicarebeneficiaries. The Patient Outcomes Research Team (PORT) performed a literature review; analyzed Medicare claims data; surveyed opthalmologists, optpmetrists, anesthesiologists, and internists; performed a prospective observation study of over 750 patients undergoing first-eye cataract surgery; analyzed patient preference on potential outcomes of cataract surgery and watchful waiting; and developled a decision analysis and epidemiologic policy model. Substantial variation was documented in the management of patients undergoing cataract surgery and the cost of alternative practice patterns, and several associated factors were identified. A reliable and valid measure of a cataract's impact on a patient's functional status was developed. This, combined with Snellen visual acuity, was found to be a better measure of patient's need for and outcome of cataract surgery than Snellen visual acuity alone. Cataract surgery's impact on patient functioning and satisfaction was characterized. Associations were defined between patient outcome and each of four factors: an ophthalmologist's annual volume of surgery, intra-operative techinque, patient characteristics, and use of YAG-laser capsulotomy. The national impacts of alternative strategies for managing cataract were projected. Findings of the study can be useful to clinicians, patients, policymakers, and researchers.