Generating a Minimum Set of Outcome Measures for Auditing Strabismus Treatments – What to Collect and How To Do It – A Delphi Exercise
John E. Somner; Peter B. Thomas; Audrey Pang; Robert Froud; Narman Puvanachandra; Melanie Hingorani;Tony Vivian
Vision and Eye Research Unit
Anglia Ruskin University, UK
Introduction: Agreeing shared datasets can drive research and quality improvement1-3. This study develops a set of outcome measures considered important and practical to collect by strabismus specialists for auditing the effectiveness of strabismus
Methods: An online Delphi exercise using the RAND/UCLA appropriateness method was conducted. 64 strabismus specialists took part. 831 cases from 3 centres were assessed for completeness of data capture. Adult Strabismus Quality of Life Questionnaire (AS-20) was prospectively collected on 100 patients and barriers to its routine use were identified using qualitative interviews and thematic analysis.
Results: Participants in the Delphi exercise agreed on 12 baseline data points, 8 indications for strabismus surgery, 4 per- and 11 post-operative complications and 10 clinical outcomes that were important and practical to collect. A reduction of, or alleviation of, patient-reported symptoms was considered the most important success measure but there was uncertainty about the practicality of measuring this in routine practice. The audit of 831 cases indicated that 79% were able to report on anatomical success while 68.5% had some comment on surgical outcome from the patient’s perspective. AS20 data was successfully captured on 100 consecutive patients and barriers to collecting quality of life data from patients identified.
Discussion: There was broad consensus on a minimum dataset for reporting the outcomes of strabismus treatments. The importance of developing the infrastructure to routinely measure both clinical and patient reported outcomes is highlighted.
Conclusion: Adoption of the minimum dataset identified could drive quality improvement but new data collection tools are required.
References: 1. Narendran N, Jaycock P, Johnston RL, et al. The Cataract National Dataset electronic multicentre audit of 55 567 operations: risk stratification for posterior capsule rupture and vitreous loss. Eye. 2008;23(1):31-37.
2. Mahmud I, Kelley T, Stowell C, et al. A Proposed Minimum Standard Set of Outcome Measures for Cataract Surgery. JAMA Ophthalmol. August 2015.
3. Rodrigues IA, Sprinkhuizen SM, Barthelmes D, et al. Defining a Minimum Set of Standardized Patient-centered Outcome Measures for Macular Degeneration. Am J Ophthalmol. 2016;168:1-12.