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Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome).

Methods: All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated.

Findings: Datasets from 20 countries were included (2005–2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1–66.6%), CSOGood was 58.9% (IQR 53.7–67.6%) and CSOPoor was 17.7% (IQR 11.3–21.1%). Coverage and quality of cataract surgery were moderately associated—every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2–50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5–7.1%) than for CSC (median 2.3% IQR -1.5–11.6%).

Conclusion: eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

No MeSH data available.


Related in: MedlinePlus

Cataract surgical coverage (CSC) and effective cataract surgical coverage                        (eCSC; persons <6/60, %) in 20 countries, 2005–2013.                    Arranged in ascending order of relative gap between CSC and eCSC (i.e. 1                        –eCSC / CSC); the gap is smallest for Argentina and largest for                        Yemen.
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pone.0172342.g002: Cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC; persons <6/60, %) in 20 countries, 2005–2013. Arranged in ascending order of relative gap between CSC and eCSC (i.e. 1 –eCSC / CSC); the gap is smallest for Argentina and largest for Yemen.

Mentions: The median eCSC (36.7% IQR 30.2–50.6%) was approximately one-third lower than the median CSC (53.7% IQR 46.1–66.6%) (Fig 2 and S2 Table). When arranged in order of the relative gap between CSC and eCSC, the surveys in Argentina, Iran and Pakistan revealed high levels of coverage (CSC 82.3%, 92.8% and 88.4% respectively) as well as relatively high levels of good outcomes (eCSC was 92%, 82% and 81% of the CSC value respectively). Next in the figure are Cambodia and the Philippines, two settings with only moderate coverage levels (43.6% and 46.9% respectively), but reasonably low gaps between CSC and eCSC, with eCSC being 79% of the CSC values in both locations. At the bottom of the figure, the countries with the largest relative gap between CSC and eCSC were Yemen (eCSC was 44% of the CSC value), Malawi (47%) and Eritrea (51%).


Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage
Cataract surgical coverage (CSC) and effective cataract surgical coverage                        (eCSC; persons <6/60, %) in 20 countries, 2005–2013.                    Arranged in ascending order of relative gap between CSC and eCSC (i.e. 1                        –eCSC / CSC); the gap is smallest for Argentina and largest for                        Yemen.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382971&req=5

pone.0172342.g002: Cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC; persons <6/60, %) in 20 countries, 2005–2013. Arranged in ascending order of relative gap between CSC and eCSC (i.e. 1 –eCSC / CSC); the gap is smallest for Argentina and largest for Yemen.
Mentions: The median eCSC (36.7% IQR 30.2–50.6%) was approximately one-third lower than the median CSC (53.7% IQR 46.1–66.6%) (Fig 2 and S2 Table). When arranged in order of the relative gap between CSC and eCSC, the surveys in Argentina, Iran and Pakistan revealed high levels of coverage (CSC 82.3%, 92.8% and 88.4% respectively) as well as relatively high levels of good outcomes (eCSC was 92%, 82% and 81% of the CSC value respectively). Next in the figure are Cambodia and the Philippines, two settings with only moderate coverage levels (43.6% and 46.9% respectively), but reasonably low gaps between CSC and eCSC, with eCSC being 79% of the CSC values in both locations. At the bottom of the figure, the countries with the largest relative gap between CSC and eCSC were Yemen (eCSC was 44% of the CSC value), Malawi (47%) and Eritrea (51%).

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome).

Methods: All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated.

Findings: Datasets from 20 countries were included (2005&ndash;2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1&ndash;66.6%), CSOGood was 58.9% (IQR 53.7&ndash;67.6%) and CSOPoor was 17.7% (IQR 11.3&ndash;21.1%). Coverage and quality of cataract surgery were moderately associated&mdash;every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2&ndash;50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5&ndash;7.1%) than for CSC (median 2.3% IQR -1.5&ndash;11.6%).

Conclusion: eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

No MeSH data available.


Related in: MedlinePlus