Evidence map›Paper›PMID 37349104›Full record

Observational studyBMJ open2023

Impact of practicing internal benchmarking on continuous improvement of cataract surgery outcomes: a retrospective observational study at Aravind Eye Hospitals, India.

Ganesh-Babu Subburaman Balu, Sachin Gupta, Ravindran D Ravilla, Thulasiraj D Ravilla, Helen Mertens, Carroll Webers, Shyam Vasudeva Rao, Frits van Merode

Abstract readObservational Study
In one paragraph

Observational study in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Slack Is Needed to Solve the Shortage of Nurses.Healthcare (Basel, Switzerland) · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Ganesh-Babu Subburaman BaluLAICO, Aravind Eye Care System, Madurai, India ganesh@aravind.org.ORCID 0000-0002-4882-4290
Sachin GuptaSC Johnson College of Business, Cornell University, Ithaca, New York, USA.
Ravindran D RavillaChairman, Aravind Eye Care System, Madurai, India.
Thulasiraj D RavillaLAICO, Aravind Eye Care System, Madurai, India.ORCID 0000-0002-1935-7443
Helen MertensMaastricht University Medical Centre+, Maastricht, The Netherlands.
Carroll WebersMaastricht University Medical Centre+, Maastricht, The Netherlands.
Shyam Vasudeva RaoMaastricht University Medical Centre+, Maastricht, The Netherlands.
Frits van MerodeCare and Public Health Research Institute (CAPHRI), Maastricht Medical Centre+, Maastricht University, Maastricht, The Netherlands.ORCID 0000-0003-1918-3487

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveWe aim to assess the effectiveness of a cataract surgery outcome monitoring tool used for continuous quality improvement. The objectives are to study: (1) the quality parameters, (2) the monitoring process followed and (3) the impact on outcomes. DESIGN AND PROCEDURES: In this retrospective observational study we evaluated a quality improvement (QI) method which has been practiced at the focal institution since 2012: internal benchmarking of cataract surgery outcomes (CATQA). We evaluated quality parameters, procedures followed and clinical outcomes. We created tables and line charts to examine trends in key outcomes.

settingAravind Eye Care System, India.

participantsPhacoemulsification surgeries performed on 718 120 eyes at 10 centres (five tertiary and five secondary eye centres) from 2012 to 2020 were included.

interventionsAn internal benchmarking of surgery outcome parameters, to assess variations among the hospitals and compare with the best hospital. OUTCOME MEASURES: Intraoperative complications, unaided visual acuity (VA) at postoperative follow-up visit and residual postoperative refractive error (within ±0.5D).

resultsOver the study period the intraoperative complication rate decreased from 1.2% to 0.6%, surgeries with uncorrected VA of 6/12 or better increased from 80.8% to 89.8%, and surgeries with postoperative refractive error within ±0.5D increased from 76.3% to 87.3%. Variability in outcome measures across hospitals declined. Additionally, benchmarking was associated with improvements in facilities, protocols and processes.

conclusionInternal benchmarking was found to be an effective QI method that enabled the practice of evidence-based management and allowed for harnessing the available information. Continuous improvement in clinical outcomes requires systematic and regular review of results, identifying gaps between hospitals, comparisons with the best hospital and implementing lessons learnt from peers.

Indexed as

CataractCataract ExtractionRefractive ErrorsBenchmarkingHospitalsHumansIndiaIntraoperative ComplicationsPostoperative ComplicationsRetrospective Studiescataract and refractive surgeryophthalmologyquality in health care

Identifiers

PMID37349104
PMCPMC10314652

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.