Tingting Chen1, Ling Jin1, Zhongqiang Zhou1, Yiwen Huang2, Xixi Yan1, Tianyu Liu1, Ee Lin Ong1, Bin Liu1, Wenyong Huang1, Beatrice Iezzi3, Mingguang He4, David S Friedman5, Nathan G Congdon6. 1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. 2. The Fred Hollows Foundation, China Program, China. 3. The Fred Hollows Foundation, Sydney, Australia. 4. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China Helen Keller International, New York, New York, United States. 5. Helen Keller International, New York, New York, United States Dana Center for Preventive Ophthalmology, Wilmer Eye Institute and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States. 6. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China ORBIS International, New York, New York, United States.
Abstract
PURPOSE: To identify factors associated prospectively with increased cataract surgical rate (CSR) in rural Chinese hospitals. METHODS: Annual cataract surgical output was obtained at baseline and 24 months later from operating room records at 42 rural, county-level hospitals. Total local CSR (cases/million population/y), and proportion of CSR from hospital and local competitors were calculated from government records. Hospital administrators completed questionnaires providing demographic and professional information, and annual clinic and outreach screening volume. Independent cataract surgeons provided clinical information and videotapes of cases for grading by two masked experts using the Ophthalmology Surgical Competency Assessment Rubric (OSCAR). Uncorrected vision was recorded for 10 consecutive cataract cases at each facility, and 10 randomly-identified patients completed hospital satisfaction questionnaires. Total value of international nongovernmental development organization (INGDO) investment in the previous three years and demographic information on hospital catchment areas were obtained. Main outcome was 2-year percentage change in hospital CSR. RESULTS: Among the 42 hospitals (median catchment population 530,000, median hospital CSR 643), 78.6% (33/42) were receiving INGDO support. Median change in hospital CSR (interquartile range) was 33.3% (-6.25%, 72.3%). Predictors of greater increase in CSR included higher INGDO investment (P = 0.02, simple model), reducing patient dissatisfaction (P = 0.03, simple model), and more outreach patient screening (P = 0.002, simple and multiple model). CONCLUSIONS: Outreach cataract screening was the strongest predictor of increased surgical output. Government and INGDO investment in screening may be most likely to enhance output of county hospitals, a major goal of China's Blindness Prevention Plan. Copyright 2015 The Association for Research in Vision and Ophthalmology, Inc.
PURPOSE: To identify factors associated prospectively with increased cataract surgical rate (CSR) in rural Chinese hospitals. METHODS: Annual cataract surgical output was obtained at baseline and 24 months later from operating room records at 42 rural, county-level hospitals. Total local CSR (cases/million population/y), and proportion of CSR from hospital and local competitors were calculated from government records. Hospital administrators completed questionnaires providing demographic and professional information, and annual clinic and outreach screening volume. Independent cataract surgeons provided clinical information and videotapes of cases for grading by two masked experts using the Ophthalmology Surgical Competency Assessment Rubric (OSCAR). Uncorrected vision was recorded for 10 consecutive cataract cases at each facility, and 10 randomly-identified patients completed hospital satisfaction questionnaires. Total value of international nongovernmental development organization (INGDO) investment in the previous three years and demographic information on hospital catchment areas were obtained. Main outcome was 2-year percentage change in hospital CSR. RESULTS: Among the 42 hospitals (median catchment population 530,000, median hospital CSR 643), 78.6% (33/42) were receiving INGDO support. Median change in hospital CSR (interquartile range) was 33.3% (-6.25%, 72.3%). Predictors of greater increase in CSR included higher INGDO investment (P = 0.02, simple model), reducing patient dissatisfaction (P = 0.03, simple model), and more outreach patient screening (P = 0.002, simple and multiple model). CONCLUSIONS: Outreach cataract screening was the strongest predictor of increased surgical output. Government and INGDO investment in screening may be most likely to enhance output of county hospitals, a major goal of China's Blindness Prevention Plan. Copyright 2015 The Association for Research in Vision and Ophthalmology, Inc.
Authors: Jacqueline Ramke; Anthony B Zwi; Juan Carlos Silva; Nyawira Mwangi; Hillary Rono; Michael Gichangi; Muhammad Babar Qureshi; Clare E Gilbert Journal: Bull World Health Organ Date: 2018-08-27 Impact factor: 9.408