A Systematic Measurement Of Clinical And Patient Reported Outcomes In Cataract Surgery: A Continuous Quality Improvement System. Pilot Study

The need for systematic measurement of clinician and patient reported outcomes after cataract surgery is greater than ever. Standardizing the way in which outcomes are measured may facilitate benchmarking, that can drive improvements in the outcomes which matter to patients. Learning to incorporate ‘patient’s voice’ in clinical practice and research enables a more complete understanding of what patients experience living with their disease and what their priorities are for treatment. Our objective was to facilitate the collection and analysis of the results reported by clinicians and patients.

This initiative has been developed at OMIQ (Oftalmologia Mèdica i Quirúrgica) Institute in Barcelona, Spain. Data has been collected systematically and all patients undergoing cataract surgery at OMIQ Institute have been enrolled. Results of the first year of data collection will be presented.

We implemented an ICHOM-based dataset, after preparation of the required IT systems, and integration of the data capture process into the clinical workflow. Clinician reported data included visual function measurements pre and post-op, pre-existing pathologies that could affect visual outcomes, surgical complications, residual refraction and type of IOL implanted.

Patient reported data were collected in a tablet, which our nurses provided to patients while they were in the waiting room, for the pre-op and post-op visits. Data included the Catquest-9SF, a satisfaction questionnaire and subjective assessment on perception of visual disturbances.

Up to date, we have registered 579 patients and 644 surgeries. We estimate to have around 900 surgeries by the time of 12 month period. Preliminary data show that 8.7% patients refused to sign the informed consent form, 9% withdrawn and 0,3% have been excluded for analysis because of errors in data collection. Patient-reported outcome measures (PROM) have been reported in 96% of the patients at pre-op and 79% at post-op visits. Clinical outcomes are analyzed globally and by surgeon, and PROM are related to type of intraocular lens, including correlation between clinician-reported outcomes measures (CROM) and PROM.

Monitoring and evaluating visual outcomes after cataract surgery will help to identify possible gaps and adopt measures to improve results. Outcome measurement enables change, and in our institution, every surgeon has its own results and the global institution another, so differences can be detected as the first step to identify a reason that can force change. Benchmarking and public reporting of data are known to lead to better performance.

This systematic collection of data allows us to adapt our practice, in order to improve clinical workflow, throughput, health outcomes and implementing patient voice showing us what matters and what is more meaningful for our patients.