Development and assessment of a priority score for cataract surgery

Fantini, Maria Pia; Negro, Antonella; Accorsi, Stefano; Cisbani, Luca; Taroni, Francesco; Grilli, Roberto

doi:10.1016/s0008-4182(04)80052-8

Cited by 21 publications

(25 citation statements)

References 11 publications

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“…More important, the appropriateness tool classifies the appropriateness of the procedure for an individual patient, and thus help to identify patients unlikely to benefit from cataract extraction. Although other studies on prioritization for cataract surgery have included patients for whom the procedure is not appropriate [13], we believe that this is detrimental to both patients and the health care system. Patients whose interventions are deemed to be inappropriate should not be prioritized until their condition has been upgraded to uncertain, at least.…”

Section: Discussionmentioning

confidence: 97%

“…Waiting lists and unmet needs also generate dissatisfaction, represent high maintenance costs [8], and lower the quality of the health care system [9]. Waiting list prioritization systems have been developed [10][11][12][13][14] to treat patients on the basis of clinical need and ethical priority rather than simply on a first-come, first-served basis that meets targets without concern for clinical priority [15]. These systems contain criteria for prioritization based on clinical conditions, social demands, and patient-based preferences.…”

Section: Introductionmentioning

confidence: 99%

“…Other tools have also been developed to evaluate the appropriateness of cataract surgery [13,21,22]. To avoid evaluating patients with multiple tools and to simplify the process, in this study we aimed to assess whether the IRYSS-appropriateness of indication for cataract surgery tool may be used both for evaluating the appropriateness of cataract extraction and prioritising patients on waiting lists for the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Can an appropriateness evaluation tool be used to prioritize patients on a waiting list for cataract extraction?

et al. 2010

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Can an appropriateness evaluation tool be used to prioritize patients on a waiting list for cataract extraction?

et al. 2010

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“…Moreover, in our model, if the priority score had not been increased to take worsening of clinical criteria with time into account, these patients would never have undergone a knee arthroplasty. The studies that analyzed prioritization of waiting lists for other procedures concluded allocating surgery according to a priority score was more beneficial than doing so by waiting time only [10,11,24,28]. Knee arthroplasty is an elective, highly cost-effective procedure [16,17].…”

Section: Discussionmentioning

confidence: 99%

Unmet Needs and Waiting List Prioritization for Knee Arthroplasty

Comas¹,

Román²,

Quintana

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background There is a high volume of unmet needs for knee arthroplasty in the population despite the increase in surgery rates. Given the long waiting times to have a knee arthroplasty, some governments have proposed prioritization systems for patients on waiting lists based on their level of need. Questions/Purposes We therefore estimated the needs and demand of knee arthroplasty in four regions of Spain during a 5-year period. Methods We developed a discrete event simulation model to reproduce the process of knee arthroplasty. The prioritization system was compared with the usual waiting list management strategy (by waiting time only).Results Under the prioritization system, patients saved an average of 4.5 months (95% confidence interval, 4.4-4.6 months) adjusted by level of need. The proportion of patients who experienced excessive waiting times was small and was associated with low levels of priority. The 5-year projection of the volume of unmet needs for knee arthroplasty remained stable; however, although the volume of need for the first knee arthroplasty decreased by 12%, the volume of need for an arthroplasty in the contralateral knee increased by 50%. Conclusions The data suggested the prioritization system was more beneficial than assigning surgery by waiting time only. The 5-year projection of the volume of unmet needs for knee arthroplasty remained stable, despite the increase in the need for contralateral knee arthroplasty. Level of Evidence Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

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“…One region has conducted two large-scale experiments of clinical prioritarisation. One of these reported the average waiting time for high-priority patients for cataract surgery being cut by 27% [54], while the other estimated a reduction of 15% in the average time waited for bone density tests and a fall of 22% in the actual number of tests made [55]. This suggests that under-funding of the SSN and inefficient services -although a problem -are not the sole causes of long waits.…”

Section: Waiting Listsmentioning

confidence: 99%

The Italian health-care system

2005

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Italy's national health service is statutorily required to guarantee the uniform provision of comprehensive care throughout the country. However, this is complicated by the fact that, constitutionally, responsibility for health care is shared between the central government and the 20 regions. There are large and growing differences in regional health service organisation and provision. Public health-care expenditure has absorbed a relatively low share of gross domestic product, although in the last 25 years it has consistently exceeded central government forecasts. Changes in payment systems, particularly for hospital care, have helped to encourage organisational appropriateness and may have contributed to containing expenditure. Tax sources used to finance the Servizio Sanitario Nazionale (SSN) have become somewhat more regressive. The limited evidence on vertical equity suggests that the SSN ensures equal access to primary care but lower income groups face barriers to specialist care. The health status of Italians has improved and compares favourably with that in other countries, although regional disparities persist.

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Development and assessment of a priority score for cataract surgery

Cited by 21 publications

References 11 publications

Can an appropriateness evaluation tool be used to prioritize patients on a waiting list for cataract extraction?

Can an appropriateness evaluation tool be used to prioritize patients on a waiting list for cataract extraction?

Unmet Needs and Waiting List Prioritization for Knee Arthroplasty

The Italian health-care system

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