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Development and assessment of a priority score for cataract surgery
Maria Pia Fantini1, Antonella Negro, Stefano Accorsi
1Agenzia Sanitaria Regionale Emilia-Romagna, Bologna, Italy.
Summary
Developing a priority score for cataract surgery waiting lists improves patient outcomes. This system ensures higher priority patients receive timely care, reducing wait times and aligning treatment with clinical need.
Area of Science:
- Ophthalmology
- Health Services Research
- Health Economics
Background:
- Clinical priority measures for surgical waiting lists often neglect indication appropriateness.
- Estimating the real-world impact of priority scores on patient wait times is crucial.
Purpose of the Study:
- To develop and validate appropriateness criteria for cataract surgery.
- To create a priority score for managing surgical waiting lists.
- To compare waiting times using a priority score versus a first-come, first-served system.
Main Methods:
- Appropriateness criteria for cataract surgery were established using the RAND method.
- A priority score was developed via regression analysis of clinical characteristics predicting clinician priority ratings.
- A computer simulation model compared waiting times under priority scoring and first-come, first-served management.
Main Results:
- 60.8% of cataract surgery indications were appropriate (mean priority 5.9), 36.8% uncertain (mean priority 4.5), and 2.4% inappropriate (mean priority 2.6).
- Key clinical factors (visual acuity, visual function, independence) explained 35% of the variance in clinician priority ratings.
- Simulation showed highest-priority patients experienced 9-27% reduced mean waiting times with the priority score system.
Conclusions:
- Priority ratings for cataract surgery waiting lists maintain coherence between priority and indication appropriateness.
- Implementing priority scores in clinical practice is potentially beneficial, offering reduced wait times for high-priority patients.