Benchmarking glaucoma primary care delivery in Australia

Purpose : A national audit of Australian optometry practices estimated the appropriateness of glaucoma primary care against evidence-derived clinical indicators. Benchmarking is a quality improvement activity; however, benchmarks for glaucoma primary care delivery do not exist. We developed benchmarks for glaucoma primary care delivery.

Methods : Normative and realistic benchmarks were developed as more than one comparator improves feedback credibility. A systematic review identified 11 glaucoma audit studies for inclusion. Compliance score averages were extracted to provide normative benchmark ranges. Realistic benchmarks were separately derived from the pre-existing nationally representative dataset using the Achievable Benchmarks of Care (ABC) method. A Bayesian adjustment was used to limit effect of small numbers of eligible patient encounters on practice appropriateness scores. ABCs were calculated from the top ten percent of Bayesian adjusted appropriateness scores. The appropriateness scores for each practice were compared to the developed benchmarks to explore distribution of practices that were at or above benchmarks.

Results : Normative benchmarks were established for 17 clinical indicators. The normative benchmarks for 8 (of 17) indicators were met by more than 80% of practices. Realistic benchmarks were calculated for 34 clinical indicators with 26 indicators having realistic benchmarks set at or above 90% appropriateness. The realistic benchmarks for 14 (of 34) clinical indicators were met by more than 80% of practices. There were 10 clinical indicators where most (>80%) of the optometry practices did not meet either benchmark (Fig). These indicators related to the identification of glaucoma risk factors (migraine history, steroid use, high and low blood pressure status), side effects of glaucoma medication, and physical examinations (applanation tonometry, gonioscopy or van Herick angle assessment, size of optic disc, pattern of neuroretinal rim, visual field assessment).

Conclusions : This study established normative and realistic benchmarks for glaucoma primary care clinical indicators. Most Australian optometry practices provided care at or above the benchmarks. Pockets of sub-optimal care delivery identified should be targeted for quality improvement. The developed benchmarks may be used to provide feedback and monitor the success of such programs.