دورية أكاديمية
Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely.
| العنوان: | Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely. |
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| المؤلفون: | Rung JM; Highmark Health, Pittsburgh, Pennsylvania. Electronic address: jillian.rung@highmarkhealth.org., Aliu O; Allegheny Health Network, Pittsburgh, Pennsylvania., Barrett TS; Highmark Health, Pittsburgh, Pennsylvania., LeJeune K; Highmark Health, Pittsburgh, Pennsylvania; Allegheny Health Network, Pittsburgh, Pennsylvania., Farah TG; Highmark Health, Pittsburgh, Pennsylvania. |
| المصدر: | Ophthalmology [Ophthalmology] 2024 May; Vol. 131 (5), pp. 577-588. Date of Electronic Publication: 2023 Dec 12. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 7802443 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1549-4713 (Electronic) Linking ISSN: 01616420 NLM ISO Abbreviation: Ophthalmology Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2000- : New York : Elsevier Original Publication: Rochester, Minn., American Academy of Ophthalmology. |
| مواضيع طبية MeSH: | Cataract Extraction*/adverse effects , Cataract*/etiology, Humans ; United States/epidemiology ; Prevalence ; Retrospective Studies ; Preoperative Care |
| مستخلص: | Purpose: Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the United States. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts postsurgical adverse events. Design: Retrospective healthcare claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania. Participants: Members aged ≥ 65 years who were continuously enrolled 6 months before and after undergoing cataract surgery from 2018 to 2021 and had approved surgery claims. Methods: Preoperative exams or tests occurring in the 30 days before surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., Current Procedural Terminology codes for blood panels and preprocedural International Classification of Diseases, 10 th Revision, Clinical Modification codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling. Main Outcome Measures: Total costs, prevalence, and strength of association as indicated by odds ratios. Results: Up to 42% of members undergoing cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed in isolation or along with clearance visits. The combined costs for the preoperative visits and tests were $4.3 million (approximately $107-$114 per impacted member). There was little difference in member characteristics between those receiving and not receiving preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member's care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two. Conclusions: Rates of routine preoperative testing before cataract surgery appear similar to those prior to the implementation of the Choosing Wisely campaign, which was meant to reduce this use. Additionally, preoperative evaluations, many likely unnecessary, were common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Cataract surgery; Claims; Healthcare waste; Low-value care; Preoperative |
| تواريخ الأحداث: | Date Created: 20231213 Date Completed: 20240422 Latest Revision: 20240422 |
| رمز التحديث: | 20240422 |
| DOI: | 10.1016/j.ophtha.2023.12.001 |
| PMID: | 38092081 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1549-4713 |
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| DOI: | 10.1016/j.ophtha.2023.12.001 |