Abstract
Aims
To develop a methodology for case-mix adjustment of surgical outcomes for individual cataract surgeons using electronically collected multi-centre data conforming to the cataract national data set (CND).
Methods
Routinely collected anonymised data were remotely extracted from electronic patient record (EPR) systems in 12 participating NHS Trusts undertaking cataract surgery. Following data checks and cleaning, analyses were carried out to risk adjust outcomes for posterior capsule rupture rates for individual surgeons, with stratification by surgical grade.
Results
A total of 406 surgeons from 12 NHS Trusts submitted data on 55 567 cataract operations between November 2001 and July 2006 (86% from January 2004). In all, 283 surgeons contributed data on >25 cases, providing 54 319 operations suitable for detailed analysis. Case-mix adjusted results of individual surgeons are presented as funnel plots for all surgeons together, and separately for three different grades of surgeon. Plots include 95 and 99.8% confidence limits around the case-mix adjusted outcomes for detection of surgical outliers.
Conclusions
Routinely collected electronic data conforming to the CND provides sufficient detail for case-mix adjustment of cataract surgical outcomes. The validation of these risk indicators should be carried out using fresh data to confirm the validity of the risk model. Once validated this model should provide an equitable approach for peer-to-peer comparisons in the context of revalidation.
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Acknowledgements
We are grateful to all the ophthalmologists who contributed data to this survey, without whose support it would not have been possible. This work was supported by a grant from the Academy of Medical Royal Colleges entitled ‘Developing a defensible decision making algorithm for revalidation based on case-mix adjusted measures of surgical performance’, which was administered through the Royal College of Ophthalmologists.
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Robert Johnston is a Director of Medisoft Limited.
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Sections of this work have been presented at: (1) The Royal College of Ophthalmologists Annual Congress, May 2010. (2) The Academy of Medical Royal Colleges, December 2010.
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Sparrow, J., Taylor, H., Qureshi, K. et al. The cataract national data set electronic multi-centre audit of 55 567 operations: case-mix adjusted surgeon's outcomes for posterior capsule rupture. Eye 25, 1010–1015 (2011). https://doi.org/10.1038/eye.2011.103
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DOI: https://doi.org/10.1038/eye.2011.103
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