| gospa68@aol.com 2005-08-09, 9:05 am |
| Dan Durrie, MD, defines "enhancement" as a fancy word for redo...as the
NYT article stated, not as a "planned procedure" as some on this URL
want you to believe. In addition, Durrie discusses how a doctor can
mis-state their true enhancement rate. Make sure you ask your doctor
what his rate is and how he tracks it (to insure that it is objective
and accurate). WK
OCULAR SURGERY NEWS 8/1/2005
Keep accurate account of enhancement rate with detailed patient
records, surgeon says
A monthly log of laser procedures can help surgeons see trends in their
surgical outcomes and prevent false tallies of enhancement rates.
Nicole Nader
--------------------------------------------------------------------------------
Surgeons can maintain an accurate record of their enhancement rates by
keeping a monthly log of laser procedures, outcomes and surgical
criteria, according to Daniel S. Durrie, MD.
In an interview with Ocular Surgery News, Dr. Durrie stressed the
importance of recording the dates of surgical procedures, enhancements
and upgrades a database or spreadsheet to streamline office
documentation and keep track of enhancement rates.
"Many people like to quote their enhancement rates," said Dr.
Durrie, OSN's Refractive Surgery Section Editor. "But often times,
these numbers aren't accurate or correct because surgeons haven't
established a criterion or system of checks and balances to ensure that
their enhancement procedures are properly documented and their rate of
procedures are correctly calculated."
He said enhancement rates can be calculated accurately with a computer
spreadsheet program, such as Excel. "A spreadsheet calculates the
figures for you and enables you to draw percentages from the data
submitted," Dr. Durrie explained.
He said the information provided to surgeons can offer valuable
feedback about their surgical outcomes and follow-up procedures, which
can be communicated to patients or used to evaluate surgical progress
over time.
"You want longitudinal data of your enhancements," Dr. Durrie said.
"It's important to watch your rate of enhancements over time to see
if your outcomes are consistent, if your rates are decreasing, and most
importantly, if you're improving in your surgical skill."
Proper documentation
In his Overland Park, Kan., refractive surgery center, Dr. Durrie
enlists the help of staff members to keep track of all laser
procedures.
"A nurse or technician records how many surgical procedures are
performed each month, and then months or years later when an
enhancement is performed we record it in the month that the original
procedure is performed. Then you can have an accurate running total
over time, " he said.
The registry should also differentiate between different types of
re-treatments, he said.
Dr. Durrie calls a re-treatment an "enhancement" if he is using the
same procedure to reach the original goal of the procedure. He defines
an upgrade as a procedure requested by former patients or new patients
who have undergone refractive surgery in the past and desire improved
visual performance with a new surgical procedure. He noted that
patients requesting wavefront-guided treatments or upgrades are often
patients who underwent LASIK before custom ablation was FDA-approved or
who are now presbyopic.
When a current patient undergoes an enhancement, the date is noted in
the registry next to the date of the first procedure. If the individual
is a new patient and not already in the registry, the patient is noted
as a new patient; this procedure is not calculated into the overall
enhancement rate, Dr. Durrie explained.
"Calculating a referral patient into the registry will falsely skew
your enhancement rate, making it higher than it actually is," he
noted.
Break down by subgroup
Dr. Durrie advises surgeons to break down their classifications when
documenting procedures to get a more accurate account of enhancement
rates. For example, he said that specifying which laser was used in a
multilaser practice helps surgeons differentiate enhancement rates
between lasers.
"Put your entries into subgroups," Dr. Durrie said. "For more
than one laser, note when laser A, B or C is used. Also, break down
your patient groups, having separate categories for myopes, hyperopes
and patients with astigmatism."
Dr. Durrie differentiates between surgery types by noting a patient's
refractive error. Patients with low myopia, between 0 D to 3 D, who
underwent laser ablation are grouped together; patients with moderate
myopia between 4 D to 7 D; and high myopia between 7 D and 10 D are
also grouped separately. Hyperopic patients are grouped into categories
of 0 D to 2 D or 2 D to 4 D.
By correlating enhancement rates to refractive errors, surgeons can
have a good idea of a patient's surgical prognosis, Dr. Durrie said.
"When you know what your average rate of enhancements is for a
certain error, you can look at a patient and say 'Oh, you're a high
myope. My enhancement rate for high myopes is 5%. But my overall
enhancement rate is just 2%,'" he said.
Dr. Durrie defines surgical terminology for the clinic:
Enhancements - "A fancy word for 're-do,' 're-operation.'
An enhancement is needed if the laser was off target during the first
ablation and left the patient with unintended aberrations."
(In his office, Dr. Durrie usually includes a free enhancement
procedure for every patient who undergoes laser ablation. Enhancements
usually take place 3 to 6 months after surgery.)
Upgrades - "Surgically 'upgrading' or improving your vision
with a new procedure after you've already had refractive surgery.
Upgrades are like going from standard television to high-definition
digital television."
(Dr. Durrie offers a 50% discount to former refractive surgery patients
who want to "upgrade" their vision.)
Bioptics/Staged Surgery - "A set of planned procedures, which both
the patient and the surgeon are aware of prior to surgery. Bioptics
usually mixes two types of refractive surgery, like phakic IOL
implantation and laser ablation."
(Dr. Durrie offers a 50% discount to bioptics patients on their second
surgery after they have paid full price for the first surgery.)
Be conscientious
Dr. Durrie said that it is important to keep good surgical records, so
that when the time comes to disclose information, physicians can be
confident of their reports.
He said that breaking down surgeries by subgroups in the registry and
differentiating between new patients and current patients who undergo
enhancements is vital to ensuring accuracy in enhancement rate
reporting.
"Not keeping good records or including enhancements of patients who
never underwent primary surgery in your center are sure-fire ways to
distort your enhancement rates," Dr. Durrie said.
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