%0 Journal Article
%T Development of appropriateness explicit criteria for cataract extraction by phacoemulsification
%A Jos¨¦ Ma Quintana
%A Antonio Escobar
%A Inmaculada Ar¨®stegui
%A and the IRYSS-Appropriateness Cataract Group
%J BMC Health Services Research
%D 2006
%I BioMed Central
%R 10.1186/1472-6963-6-23
%X Criteria were developed using a modified Delphi panel judgment process. A panel of 12 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the influence of all variables on the final panel score using linear and logistic regression models. The explicit criteria developed were summarized by classification and regression tree analysis.Of the 765 indications evaluated by the main panel in the second round, 32.9% were found appropriate, 30.1% uncertain, and 37% inappropriate. Agreement was found in 53% of the indications and disagreement in 0.9%. Seven variables were considered to create the indications and divided into three groups: simple cataract, with diabetic retinopathy, or with other ocular pathologies. The preoperative visual acuity in the cataractous eye and visual function were the variables that best explained the panel scoring. The panel results were synthesized and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel original criteria, was 5.3%.The parameters tested showed acceptable validity for an evaluation tool. These results support the use of this indication algorithm as a screening tool for assessing the appropriateness of cataract extraction in field studies and for the development of practice guidelines.Cataract is very prevalent in developed countries, and the incidence is expected to increase as the result of the aging of the population and increased life expectancies [1]. In addition, cataract extraction is the most common surgical intervention in developed countries [2]. Due to the high prevalence of this condition, clinicians, managers, and health payers must decide who should undergo cataract extraction. Variations in the use of cataract extraction also have been reported, which led to the need to study if overuse or underuse of the procedure was occurring [3-5]. The final goals are to increase the quality of care and the cost
%U http://www.biomedcentral.com/1472-6963/6/23