A systematic approach to evaluate practice-based process- and outcome data applied to the treatment of neovascular age-related macular degeneration

Autor: Mari Elshout, Margriet I. van der Reis, Carroll A.B. Webers, Tos T. J. M. Berendschot, Jan S. A. G. Schouten, Yvonne de Jong-Hesse
Přispěvatelé: MUMC+: MA AIOS Oogheelkunde (9), Oogheelkunde, MUMC+: MA Oogheelkunde (9), RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, RS: MHeNs - R3 - Neuroscience, MUMC+: MA Oogheelkunde (3), Medical Image Analysis, Ophthalmology
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Vascular Endothelial Growth Factor A
Visual acuity
visual acuity
Angiogenesis Inhibitors
Photodynamic therapy
0302 clinical medicine
lcsh:Ophthalmology
VISUAL-ACUITY
030212 general & internal medicine
Fluorescein Angiography
SUBFOVEAL CHOROIDAL NEOVASCULARIZATION
Aged
80 and over
Photosensitizing Agents
SECONDARY
Medical record
Confounding
General Medicine
Bevacizumab
Outcome and Process Assessment
Health Care
Cohort
Intravitreal Injections
DELAY
Female
medicine.symptom
medicine.drug
Cohort study
Research Article
medicine.medical_specialty
DOSING REGIMEN
03 medical and health sciences
Internal medicine
Ranibizumab
medicine
Humans
outcome study
VERTEPORFIN THERAPY
Aged
Retrospective Studies
INTRAVITREAL BEVACIZUMAB AVASTIN
business.industry
Age-related macular degeneration
Anti-VEGF
Verteporfin
Macular degeneration
medicine.disease
Choroidal Neovascularization
Ophthalmology
RANIBIZUMAB TREATMENT
Photochemotherapy
lcsh:RE1-994
030221 ophthalmology & optometry
Wet Macular Degeneration
business
FOLLOW-UP
Follow-Up Studies
Zdroj: BMC Ophthalmology, 20(1):21. BioMed Central Ltd
BMC Ophthalmology, 20(1):21. BioMed Central
BMC Ophthalmology
van der Reis, M I, Elshout, M, Berendschot, T T J M, de Jong-Hesse, Y, Webers, C A B & Schouten, J S A G 2020, ' A systematic approach to evaluate practice-based process-and outcome data applied to the treatment of neovascular age-related macular degeneration ', BMC Ophthalmology, vol. 20, no. 1, 21, pp. 21 . https://doi.org/10.1186/s12886-020-1303-y
BMC Ophthalmology, Vol 20, Iss 1, Pp 1-10 (2020)
ISSN: 1471-2415
DOI: 10.1186/s12886-020-1303-y
Popis: BackgroundFollowing the principles of value-based health care, outcomes and processes of daily-practice eye care need to be systematically evaluated. We illustrate an approach that can be used to support data-driven quality improvements. We used patient data regarding the treatment of neovascular age-related macular degeneration (nAMD).MethodsIn a cohort study, we reviewed medical records of patients with nAMD confirmed on fluorescein angiography (FA). Patients were treated with intravitreal injections with bevacizumab; ranibizumab; or photodynamic therapy (PDT). Visual acuity (VA), ophthalmic exam results and treatments were recorded. VA was compared between treatments by linear mixed model. Diagnosis was re-evaluated on the original FAs. Outcome analysis was performed by 1) selecting VA as the relevant outcome parameter; 2) Preventing selection by comparing treatments with historical untreated cohort and cohorts from the literature, 3) correcting for confounding due to lesion type, and 4) identifying relevant process variables that affect the outcome. These were severity of disease at presentation, and doctor- and patient dependent process variables.ResultsIn total, 473 eyes were included. At 12 months, change in VA was 0.54, 0.48, 0.09, and 0.07 LogMAR in the no-treatment, photodynamic therapy (PDT), bevacizumab, and ranibizumab groups, respectively. Lesion type on FA differed between groups. Diagnosis of nAMD could not be confirmed in 104 patients. Patient delay, inaccurate diagnosis and treatment intervals may have impacted outcomes.ConclusionsThe effect of PDT was small to absent. Anti-VEGFs were effective and appeared as effective as in RCTs. Correct selection of a comparator cohort and addressing confounding, including confounding by indication and effect modification, are needed to achieve valid results and interpretation. Patient delay, diagnosis accuracy, indication for and application of treatment can potentially be improved to improve treatment outcomes. In a value-based care perspective, systematic evaluation of diagnostic accuracy, treatment indication, protocols, and outcomes of new interventions is needed at an early stage to improve outcomes.
Databáze: OpenAIRE
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