Transcript QUALITY EYE CARE STANDARDS AND MANAGED CARE FOR …

Financial Disclosure

I have the following financial interests or
relationships to disclose:
– OMIC-Ophthalmic Mutual Insurance Company
- C,L,
– Santen, Inc.
- C,
PRACTICE GUIDELINES IN
DEVELOPING COUNTRIES:
THE CHINA EXPERIENCE
ACADEMIA OPHTHALMOLOGICA INTERNATIONALIS
INAUGURAL LECTURE
OCTOBER 24, 2009
SAN FRANCISCO
RICHARD L. ABBOTT, M.D
THOMAS W. BOYDEN HEALTH SCIENCES PROFESSOR OF OPHTHALMOLOGY
UNIVERSITY OF CALIFORNIA SAN FRANCISCO
SENIOR ADVISOR FOR INTERNATIONAL EDUCATION
AMERICAN ACADEMY OF OPHTHALMOLOGY
CHAIRMAN
CLINICAL GUIDELINES COMMITTEE
INTERNATIONAL COUNCIL OF OPHTHALMOLOGY
DOES ONE SIZE FIT
ALL?
WHAT HAVE WE LEARNED FROM
CHINA AND CAN IT BE APPLIED TO
OTHER COUNTRIES?
CLINICAL PRACTICE
GUIDELINES
PROJECT IN CHINA
COLLABORATIVE EFFORT
BETWEEN:
COS
CLINICAL PRACTICE
GUIDELINES PROJECT IN
CHINA
DEVELOPMENT PHASE
(2004-2006)
CLINICAL PRACTICE
GUIDELINES PROJECT IN
CHINA
FOUR STEPS
Development
 Promotion

– Awareness
– Agreement
– Adoption
– Compliance
PROMOTION OF CLINICAL
PRACTICE GUIDELINES IN
CHINA
BEIJING 2006
AWARENESS
Must know that they
exist
 Must be familiar with
concept
 Must have
educational programs

WHAT HAVE WE LEARNED
FROM CHINA AND HOW CAN
IT BE APPLIED TO OTHER
COUNTRIES?
PROCESS FOR
IMPLEMENTATION

Work through governmental, national
and local societies

Create a “steering committee” of
interested and influential leaders
THANK YOU!
谢谢!
KEY PRINCIPLES

LOCAL LEADERSHIP AND STRONG DESIRE TO
IMPROVE QUALITY OF CARE (ZEALOT(S)!)

NEED FUNDING TO SUPPORT WORK

STRUCTURE OR ROAD MAP ON STEPS REQUIRED TO
SUCCEED

INCENTIVES TO FOLLOW GUIDELINES
HOW ARE GUIDELINES BEST
INCORPORATED INTO CLINICAL
PRACTICE?
 Create
awareness through:
– Wide dissemination
– Education process (meetings,
journals, internet)
– 14th COS Congress in Chongqing
had entire day of seminars
Physician compliance
with guideline use
is significant challenge
COMPLIANCE

Ease of incorporation into practice

Minimal change required by physician

Minimal cost

Little time constraints
COMPLIANCE
 Need Incentives
– Bonus
– Lower costs
– More patients
– Recognition
(or Penalties)
– Lower re-imbursement
– Loss of licensure
GOVERNMENT
SUPPORT
MINISTRY OF HEALTH
RECOGNITION (April, 2009)!
STUDIES IN CHINA TO EXAMINE
AWARENESS OF PPPs AND
BARRIERS TO USE (COMPLIANCE)

EYE CENTER OF PEOPLES HOSPITALPEKING UNIVERSITY
– Professor Li Xiaoxin

TONGREN HOSPITAL – BEIJING
– Professor Wang Ningli
美国眼科临床指南的适用性研
究
Assessment of Ophthalmological Care
Before and After the Introduction of
Clinical Practice Guidelines in 3rd level
Hospitals in Beijing
——青光眼部分(Glaucoma section)
北京同仁眼科中心
Beijing Tongren Eye Center
王宁利
Ningli Wang
20
Question 1:
Why do we have to implement
CLINICAL PRACTICE GUIDELINES in
China?
21
Answer:
Lack of consistent quality and evidence
based diagnosis and treatment in China.
22
Tongren survey result:
 Most
of the doctors in 3rd level
hospital know about clinical
guideline content.
 But
few doctors completely
follow recommendations in their
clinical work.
23
TONGREN HOSPITAL SURVEY
RESULTS

GLAUCOMA
(TONGREN VS PROVINCIAL HOSPITAL)
– ONH EVALUATION FOR GLAUCOMA PT?
 TONGREN: 100%
 PROVINCIAL: 35%
– INQUIRE ABOUT SYSTEMIC MECICAL HX?
 TONGREN:98%
 PROVINCIAL: 77%
– TARGET PRESSURE FOR EACH PT?
 TONGREN: 52%
 PROVINCIAL: 6%
– RECORD TIME OF IOP MEASURMENT?
 TONGREN: 44%
 PROVINCIAL: 14%
Question 2:
Why have Clinical Guidelines not
been implemented in China?
25
Answer:
Current practice pattern of diagnosis &
management in China difficult to meet
requirements of clinical guideline
26
EXAMPLE OF CLINICAL GUIDELINE FOR
ANGLE CLOSURE GLAUCOMA
 Gonioscopy [A:Ⅲ]
 Documentation of the optic disc morphology, best
performed by color stereophotography or
computer based image analysis [A:Ⅱ]
 Visual field evaluation [A:Ⅲ]
 topical medications constitute effective initial
therapy [A:Ⅲ]
27
Example:
Gonioscopy
• lens often not available
• time-consuming
• no re-imbursement
optic disc morphology
• no computer based image analysis center
• time-consuming
• no re-imbursement
Visual field
• lack of equipment
• waiting period too long
• many patients lost to follow-up
topical medications
• no or limited education for patients
• poor compliance
28
Question 3:
How do we implement clinical
guidelines in China?
Require Administrative intervention?
29
Answer:
Its not easy!
High volume of patients would require
more to be done for each patient!
 Doctors’
work load would be increased
30
Question 4:
What can we do now?
31
Answer:
Set up a simple, convenient and
efficient diagnosis & management
system that can integrate with
clinical guidelines
32
Modify current medical record
format according to PPP
EX: Gonioscopy Descriptive
Static:
OD
Pigment trabecular
Dynamic:
OS
0: No-see. ( Label in quadrant area.)
1: see
Delineate PAS extent and degree by line.
OD│_│ 个钟点
OD│_│ 个钟点
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FAILURE TO IMPLEMENT
GUIDELINES

NOT CREDIBLE TO PRACTITIONER

TOO COMPLEX

REQUIRES RESOURCES THAT ARE NOT READILY
AVAILABLE

RADICALLY DIFFERENT FROM PREVAILING
TREATMENT NORM
THANK
THANK YOU!!
YOU!!