Adherence, underperformed and overperformed test rates – Novel metrics for reporting compliance to clinical guidelines

Abstract

Background: Compliance to guidelines ensures evidence-based care, critical to optimal patient outcomes. There is currently no common and comprehensive method of reporting compliance to guidelines across multiple ocular conditions. Moreover, IP optometrist activity has yet to be evaluated in this manner. This paper presents novel metrics to promote the standardised reporting of compliance to clinical guidelines. Methods: Three novel metrics were developed; adherence (A), overperformed test rate (OP), and underperformed test rate (UP). These metrics were used to evaluate 822 first patient appointments collected over the course of a year (Nov 2018 - Oct 2019) by four specialist IP Optometrists (Acute Primary Care Ophthalmology Service, Kent). Compliance across 76 quality indicators (recommended tests) covering history and symptoms, clinical signs, management, and prescribing decisions was measured against the College of Optometrists’ Clinical Management Guidelines. Results: The metrics (mean and range) are as follows. History and symptoms, A: 78.9% (range: 48–98%), OP: 6.9% (range: 0-13.7%) and UP: 14.2% (range: 1.2-4.5%). Clinical signs (tests undertaken), A: 93.8% (61-99%), OP: 2.8% (range: 0-14%) and UP: 3.4% (range: 0-28%). Management decisions, A: 69.6% (range: 61-100%), OP: 3.1% (0-12%) and UP 27.3% (range: 0-57%). Prescribing decisions, A: 92.1% (range: 61-100%), MOP: 0.9% (range: 0-5%) and UP: 7.1% (range: 0-35%). Conclusion: The three novel metrics provide a comprehensive method of reporting compliance to guidelines. IP optometrist activity appears largely compliant against CMG recommendations across 48 anterior ocular conditions. Further work is being undertaken to explore the relationship between clinical observations and decisions made by IP optometrists.