Abstract
PURPOSE: Improving adherence to practice guidelines can improve patient safety and quality of care. We sought to establish a regional glaucoma physician collaborative to evaluate and improve adherence to the American Academy of Ophthalmology's Primary Open-angle Glaucoma (POAG) Preferred Practice Pattern (PPP) guidelines. DESIGN: Prospective interventional study. METHODS: The collaborative consisted of 13 glaucoma specialists from 3 practices in Michigan. All consecutive POAG new patient visits were reviewed from each study site to determine physician adherence to the 13 major examination elements of the PPP. In phase 1 of the study, physician adherence rates for each of the recommended examination elements were combined and averaged for all groups. Averages for the collaborative were reported to each site, and each physician received his or her individual adherence rates. Physicians discussed strategies to improve overall adherence to the PPP. Adherence rates were collected in phase 2 to determine if feedback and sharing of strategies resulted in improved adherence. RESULTS: A total of 274 new POAG patient visits from phase 1 and 280 visits from phase 2 were reviewed. After accounting for multiple comparisons, overall improvement approached statistical significance for the evaluation of visual function (91.2% to 96.1%, P < .02) and target intraocular pressure determination (73.7% to 83.2%, P < .01). Improvement for other measures that had a high rate of adherence at baseline (eg, ocular history, pupil examination, and central corneal thickness measurement) was not statistically significant. CONCLUSIONS: It is feasible to establish a regional glaucoma physician collaborative to improve standardization of care for patients with newly diagnosed POAG.