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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Mort Soroka, PhD, David Krumholz, OD, Joan Portello, OD, and Lesley Reis. State College of Optometry, State University of New York, 33 West 42 Street, New York, NY 10036, 212-780-5024, msoroka@sunyopt.edu
This study was designed to examine the delivery of eye care services by optometrists, ophthalmologists, and other primary health care providers in a number of Health Maintenance Organizations. Three HMOs were selected on the basis of differences in the utilization of eye care providers, availability of eye care data, and willingness to allow outside auditors to review the clinical records of patients. Although all three HMOs have similar eye care benefits and provide comparable care, there are distinct differences in the availability and utilization of eye care providers at each site.
Site visits were made to each HMO by two clinicians experienced in quality assurance and six diagnoses were examined through detailed medical record reviews. The ICDM-9 codes for these six conditions, conjunctivitis, corneal abrasion/erosion, cataract, diabetic retinopathy, glaucoma, and macular degeneration, were used to provide a random sample of patient records with these diagnoses from each site. At least 30 patients for each diagnosis were selected for review.
Our findings suggest that optometrists play a large role in the delivery of care to patients with both short-term acute eye care conditions and long-term chronic eye conditions, whether they provide the care exclusively or in conjunction with an ophthalmologist. Therefore, the cost-effectiveness of utilizing the services of less costly eye care providers capable of delivering the high quality eye care can be demonstrated and potential cost savings may accrue if the roles, functions, and availability of eye providers are changed.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to
Keywords: Managed Care, Vision Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.