Outcomes analysis using a medical database a necessary, powerful tool for refractive surgeons

Las Vegas-Refractive surgery outcomes analysis using a medical database provides critical information for improving treatment success and practice profitability, said Perry S. Binder, MD, here at Refractive Surgery Subspecialty Day, part of the annual meeting of the American Academy of Ophthalmology.

"Optimizing treatment accuracy with current excimer laser technologies relies on ongoing nomogram adjustments, but outcomes analysis also empowers surgeons to make rational choices for patients and key administrative decisions. Furthermore, outcomes data are required by some third-party payers and can assist in preparing for meeting presentations and in writing manuscripts," he said. "Most importantly, however, they provide a service that patients are seeking. Individuals interested in having refractive surgery will want to know in detail about your personal results, and if you can provide that information, then you can set yourself apart from the competition."

In addition, some electronic medical record systems "handshake" with some outcomes analysis programs through automatic data transfer. Ultimately, the analysis will lead to improved outcomes that will translate into increased referrals and, thereby, improved profitability.

"If you and your staff are not committed to this endeavor, you will not obtain useful information. When approached with dedication, I guarantee it will simplify and improve your life because of its many advantages," Dr. Binder commented.

Two basic types

Among commercially available software databases, surgeons can choose from either an aggregate or an individual data approach. An aggregate type of database will allow comparisons between the surgeon and other groups and physicians. It can detect errors and trends but offers limited analyses because it has limited data entry fields. Furthermore, errors in data entry and variability in the entry skills of other users may lead to a contaminated database that would invalidate comparisons.

"When working with a group database, there is a potential for bad outcomes to be disproportionately reported. However, existing systems can identify anomalous centers and exclude them from group analyses as well as eliminate data error entries," Dr. Binder said.

An individual database avoids the aforementioned issue and also provides more powerful analyses while allowing personalization of results to individual patients. It is more time-consuming, however, and depending on the surgeon's needs, it can be staff intensive, too, he said.

Building the database

For outcome analyses to be accurate, results are needed from at least one valid postoperative examination. That requirement may cause a change in operations for some practices.

"Even patients who are satisfied with their outcome will need to have a more thorough evaluation with refraction and keratometry. But remember, 'garbage in' yields 'garbage out,' so inaccurate or incomplete data collection can lead to invalid conclusions," Dr. Binder said.

Sample analyses and reports

He described some examples of types of questions that can be investigated using outcomes analyses systems.

A simple analysis might calculate results for customized LASIK in eyes treated only for spherical error, flap parameters for a given intended flap thickness, or overall enhancement rates.

A moderately complex analysis might determine enhancement rates for more specific situations, such as spherocylindrical treatments using a single laser platform and flap creation system.

At an even higher level, the system could be asked to calculate results for spherocylindrical treatments comparing two surgeons using one flap creation system but two different laser platforms and including only patients in a certain age range who did not have monovision treatment and were treated within a given spherical equivalent range.

The system also can be asked to generate special reports, such as a letter to a prospective patient describing outcomes achieved to date in cases with similar characteristics or a summary to be sent to a single referral source listing outcomes from cases received over a recent period of time.

"These reports can be obtained with little effort on your part and can be powerful for attracting more patients to your practice," said Dr. Binder.

He concluded by describing the data entered into an outcomes analysis program as a "gold mine" that grows as the years progress. Dr. Binder again reminded his colleagues that they can expect to get out of the system only what they put in, and he cautioned them to be prepared to be humbled by the findings.

"Many times I have been surprised to see that my gut impressions and anecdotal opinions about my outcomes were incorrect when compared with results that were generated based on real and accurate data," Dr. Binder said.