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Optometry prepares for evidence-based care

June 17, 2013

Microsoft Word - 6 - EBO guideline chart.docEvidence-based health care is more than just a fashionable buzz word in the world of health care policy and planning. It is an international movement to ensure health care practitioners can readily access the latest scientifically verified clinical information at the point of care and then apply it to benefit their patients, said AOA Evidence-Based Optometry Committee Chair Diane T. Adamczyk, O.D.

“This will have a tremendous impact on the day-to-day practice of optometry,” Dr. Adamczyk said. “These are going to be go-to guides that allow the practicing optometrist to easily access the latest and best research and use it to provide care for the patient.”

Over the coming years, proponents believe evidence-based practice will markedly improve health care quality by ensuring patients are diagnosed and treated based on the best available scientific research.

“Evidence-based health care is where health care is heading,” Dr. Adamczyk said.

Health care entities around the world are now working to make their guidelines evidence-based, following the Institute of Medicine (IOM) report “Clinical Practice Guidelines We Can Trust” released in March 2011.

Members of the AOA Clinical Resources Group Diabetes Guideline Development Group gathered for the March 22-23 reading of the draft for the new evidence-based guideline. From top row left are Danette Miller, AOA manager of quality improvement; William Hsu, M.D., endocrinologist with the Joslin Diabetes Center;  Paolo Antonio Silva, M.D., ophthalmologist affiliated with the Beetham Eye Institute and Joslin Diabetes Center; Carl Urbanski, O.D.; John Amos, O.D.; Linda Chous, O.D.; Felix Barker, O.D.; Lori Grover, O.D., Ph.D.; David Masihdas, O.D.; Lynn Greenspan, O.D.; Alisa Krewet, AOA quality improvement coordinator; Stephen Miller, O.D.; and Bennett McAllister, O.D.  From front row left are Evelyn Smith DeMille, Joslin Diabetes Center patient; Tina MacDonald, O.D.; Diane Adamczyk, O.D., chair of the AOA Evidence-Based Optometry Committee; Beth Kneib, O.D., director of AOA Clinical Resources Group; and Katherine Killilea, Joslin Diabetes Center patient advocate. Not pictured are AOA Clinical Guideline Development Group members Jerry Cavallerano, O.D., Ph.D., of the Joslin Diabetes Institute, and A. Paul Chous, O.D.

Members of the AOA Clinical Resources Group Diabetes Guideline Development Group gathered for the March 22-23 reading of the draft for the new evidence-based guideline. From top row left are Danette Miller, AOA manager of quality improvement; William Hsu, M.D., endocrinologist with the Joslin Diabetes Center; Paolo Antonio Silva, M.D., ophthalmologist affiliated with the Beetham Eye Institute and Joslin Diabetes Center; Carl Urbanski, O.D.; John Amos, O.D.; Linda Chous, O.D.; Felix Barker, O.D.; Lori Grover, O.D., Ph.D.; David Masihdas, O.D.; Lynn Greenspan, O.D.; Alisa Krewet, AOA quality improvement coordinator; Stephen Miller, O.D.; and Bennett McAllister, O.D. From front row left are Evelyn Smith DeMille, Joslin Diabetes Center patient; Tina MacDonald, O.D.; Diane Adamczyk, O.D., chair of the AOA Evidence-Based Optometry Committee; Beth Kneib, O.D., director of AOA Clinical Resources Group; and Katherine Killilea, Joslin Diabetes Center patient advocate. Not pictured are AOA Clinical Guideline Development Group members Jerry Cavallerano, O.D., Ph.D., of the Joslin Diabetes Institute, and A. Paul Chous, O.D.

The National Guideline Clearinghouse, a component of the Agency for Healthcare Research and Quality (AHRQ), houses most U.S. guidelines, making them accessible to the public, including practitioners. These guidelines are compiled and evaluated by panels of respected experts in their fields, using a structured IOM process to determine its value using a variety of sources, from the latest in breakthrough research to long-established standards of care.

“The goal is to make the best available, scientifically validated clinical information readily available in usable form for practitioners to apply in day-to-day practice,” Dr. Adamczyk said.

Health care practitioners in virtually all disciplines face challenges in keeping abreast of all the advances in their fields. Research in eye care over recent years has yielded discoveries in adaptive optics, imaging, corneal infection, objective retinal function fields, nano-medicine, stem cell research, genomics, and many other areas. And the volume of research produced each year can only be expected to grow, Dr. Adamczyk noted.

“No optometrist has the time to read all of the published clinical research, evaluate it, and incorporate it into practice,” Dr. Adamczyk said. “The goal for the AOA Evidence-Based Committee is to provide busy, practicing optometrists the resources that allow them to quickly access the most recent research and use it to benefit patients.”

The AOA Clinical Resources Group (CRG) launched its Evidence-Based Optometry Project in 2011 as part of the AOA CRG’s Quality Improvement Committee. AOA President Ronald Hopping, O.D., MPH, established a stand-alone AOA Evidence-Based Optometry Committee within the AOA CRG in 2012.

The committee’s initial charge is to update the “AOA Clinical Practice Guidelines on Care of the Patient with Diabetes” to meet the stringent IOM standards (see “Making the shift to evidence-based clinical practice guidelines,” AOA News, November 2012).

The diabetes guideline is scheduled for release later this year. Eventually, all 20 of the AOA’s Clinical Practice Guidelines will be updated using the IOM methodology standards.

Developing evidence-based guidance that meets the demanding standards of the IOM is no small task, Dr. Adamczyk said.

Developing evidence-based guidance

Optometry has been a leader in the development of clinical practice guidelines. The AOA released its first clinical guidelines in the early 1990s, under the leadership of John Amos, O.D., a current committee member, when few other professions were developing such guidance.

“Evidence-based clinical practice guidelines for optometrists must be developed from the point of view of an optometrist,” Dr. Adamczyk said. Otherwise, such guidance might not be truly useful in helping optometrists care for their patients.

To meet IOM standards and ensure the guidelines are credible to other health care disciplines and health care administrators, the guidelines must also reflect the perspective of related health care experts, policy experts, patients, and patient advocates. Development of evidence-based clinical guidance meeting IOM criteria involves a 14-step process (see box on page 48), undertaken by a specially appointed guideline development group (GDG).

For its Diabetes Guideline Development Group, the AOA has recruited not only a roster of top optometric researchers, policy experts, educators, authors and practitioners but an endocrinologist, a retinal specialist, a patient and a patient advocate from the Harvard Medical School’s highly respected Joslin Diabetes Center.

In the case of the AOA’s new evidence-based diabetes guideline, more than 500 scientific papers have so far been identified and screened for relevance. Of those, 258 articles were reviewed and graded for strength of evidence and clinical recommendations by two independent development group members. In addition, more than 200 studies will be used in background information accompanying the guidelines.

“All of those totals will increase as additional studies are found and reviewed,” Dr. Adamczyk said.

Importance of the guidelines

Over the coming months and years, strong evidence-based clinical practice guidelines will be increasingly demanded in all health care disciplines.

Hospitals and other health care institutions are already requiring evidence-based practice of any practitioners to whom practice privileges are granted.

Health care professionals will expect evidence-based practice of any practitioners to whom they refer patients.

Savvy patients will likewise come to expect evidence-based care, Dr. Adamczyk believes.

Many health care policymakers would like to see adherence to evidence-based care guidance become a factor in reimbursement under value-based payment systems.

It will likely become a requirement for participation in new care models such as medical homes or accountable care organizations.

Evidence-based care guidelines will be used for decision support in electronic health records programs.

Clinical guidelines are already a factor in malpractice cases.

“As a result of this AOA initiative, optometrists – and their patients, will soon have the benefit of strong, evidence-based clinical eye and vision care guidelines that meet the highest IOM standards,” Dr. Adamczyk said. “Not only is this project critical to ensuring optometry maintains its place as an integral part of the health care community, it will ensure that clinical guidelines for optometrists will be developed by optometrists, making it truly useful in providing the best possible care for patients.”

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