Resident Compliance With AAO Preferred Practice Patterns for POAG Suspects
Journal of Glaucoma
Mihlstin et al. examined resident compliance with the American Academy of Ophthalmology Preferred Practice Patterns (PPPs) for primary open-angle glaucoma suspects (POAGS) in a resident ophthalmology clinic. After analyzing data from 200 patient charts, the authors found that compliance was high overall (73.8%), although the level of compliance varied markedly among the elements of the PPP.
The 200 charts were randomly selected from those of adult patients with the ICD diagnostic code for POAGS at their initial visit to the Kresge Eye Institute resident clinic. Electronic medical records were evaluated for documentation and compliance with 17 elements in the PPP, in the areas of history, examination, and patient education.
The overall mean compliance was 73.8% for all charts and was similar across training levels: 74.4% for first-year residents (n = 53), 74.5% for second-year residents (n = 38), and 73.3% for third-year residents (n = 109). For the 3 elements of history, overall compliance was 92%.
For the 10 elements in the examination category, the overall compliance rate was 88%. Although compliance was 99%-100% on the elements of best-corrected visual acuity, pupillary reaction, slit-lamp examination, and IOP measurement, there was moderate compliance (84%-85%) for the elements of optic nerve head/retinal nerve fiber analysis and visual field evaluation. Substantially lower compliance was found for 2 examination elements: gonioscopy (46%) and central corneal thickness (69%).
Compliance was lowest for the 4 elements of patient education, at 26% overall. Only 5% of charts included documentation of discussion of diagnosis, risk factors, management, and prognosis; while no charts documented discussion of the chronic nature of treatment and potential physical or emotional effects of long-term treatment.
The authors concluded that residents’ compliance was high for most elements of the PPPs for POAGS, but they identified specific areas of poor compliance, especially concerning patient education. They noted that adherence to PPPs can be a helpful method of assessing resident performance.
The original article can be found here.