Can the appropriateness of eye care be measured through cross-sectional retrospective patient record review in eye care practices in Australia? The iCareTrack feasibility study

Abstract

ObjectivesThe CareTrack study found that a wide range of appropriateness of care (ie, care in line with evidence-based or consensus-based guidelines) was delivered across many health conditions in Australia. This study therefore aimed to demonstrate the feasibility of using the CareTrack method (a retrospective onsite record review) to measure the appropriateness of eye care delivery.DesignCross-sectional feasibility study.Setting and participantsTwo hundred and thirteen patient records randomly selected from eight optometry and ophthalmology practices in Australia, selected through a combination of convenience and maximum variation sampling.MethodsRetrospective record review designed to assess the alignment between eye care delivered and 93 clinical indicators (Delphi method involving 11 experts) extracted from evidence-based clinical practice guidelines.Primary outcome measureNumber of eligible patient records, sampling rates and data collection time. This feasibility study also tested the ability of 93 clinical indicators to measure percentage appropriate eye care for preventative, glaucoma and diabetic eye care. A secondary outcome was the percentage of practitioner–patient encounters at which appropriate eye care was received.ResultsA median of 20 records (range 9 to 63) per practice were reviewed. Data collection time ranged from 3 to 5.5 hours (median 3.5). The most effective sampling strategy involved random letter generation followed by sequential sampling. The appropriateness of care was 69% (95% CI 67% to 70%) for preventative eye care, 60% (95% CI 56% to 58%) for glaucoma and 63% (95% CI 57% to 69%) for diabetic eye care.ConclusionsAppropriateness of eye care can be measured effectively using retrospective record review of eye care practices and consensus-based care indicators.

iCareTrack: measuring the appropriateness of eyecare delivery in Australia

“…The study protocol 7,8 was based on the CareTrack Australia protocol 9 and the RAND methodology 4 . In the CareTrack study, a random stratified sample of 1154 clinical records were reviewed against a set of 522 clinical indicators developed from clinical practice guidelines and consensus from clinical experts.…”

“…As the appropriateness of eyecare delivery had been not measured by the CareTrack study, a retrospective cross‐sectional record review was conducted onsite in a randomised sample of optometry practices, stratified by Australian state. The feasibility of using the CareTrack method 5 to measure the appropriateness of eyecare delivery was initially established and is described elsewhere 8 …”

“…Sets of clinical indicators that represented appropriate eyecare in 2013 and 2014 for the three conditions were developed. These were adapted from recommendations extracted from nine evidence‐based clinical practice guidelines and reviewed by experts (six optometrists and five ophthalmologists) using a Delphi method 8 . The guidelines were published between the years 2007 and 2012 with three from Canada and two each from Australia, UK, and USA.…”

“…Each of the 85 indicators was sub‐classified into one of four domains of care: history taking, physical examination, recall period and referral. A separate study has demonstrated the feasibility of eyecare measurement using these indicators 8 …”

Design and use of vignettes to investigate referral decision-making by optometrists

“… 18 While variation in management in glaucoma and diabetic eye care has been found by record abstraction, capturing referral data by record abstraction is challenging. 19 …”