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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

Absolute inequality between women and men in cataract surgical coverage                            (CSCpersons <6/60), and effective cataract surgical                        coverage (eCSCpersons <6/60) in 20 countries,                        2005–2013.                    Absolute inequality is the difference between women and men (e.g. CSC in                        men–CSC in women); a positive value indicates women are worse off.                        Horizontal dashed lines and labels indicate the median values of all                        studies. Grey shading indicates the inter-quartile range (middle 50% of                        studies).
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pone.0172342.g003: Absolute inequality between women and men in cataract surgical coverage (CSCpersons <6/60), and effective cataract surgical coverage (eCSCpersons <6/60) in 20 countries, 2005–2013. Absolute inequality is the difference between women and men (e.g. CSC in men–CSC in women); a positive value indicates women are worse off. Horizontal dashed lines and labels indicate the median values of all studies. Grey shading indicates the inter-quartile range (middle 50% of studies).

Mentions: Gender inequality was present for both CSC and eCSC. Despite large variation between countries, on average women were worse off than men for both indicators (Fig 3). Gender inequality remained after controlling for possible age differences between women and men—logistic regression showed women were more likely than men to have worse CSC (OR 1.3, 95%CI 1.1–1.6) and worse eCSC (OR 1.3, 95%CI 1.0–1.5). The average level of inequality in eCSC (median 4.6% IQR 0.5–7.1%) was slightly higher than CSC (median 2.3% IQR -1.5–11.6%).


Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage
Absolute inequality between women and men in cataract surgical coverage                            (CSCpersons <6/60), and effective cataract surgical                        coverage (eCSCpersons <6/60) in 20 countries,                        2005–2013.                    Absolute inequality is the difference between women and men (e.g. CSC in                        men–CSC in women); a positive value indicates women are worse off.                        Horizontal dashed lines and labels indicate the median values of all                        studies. Grey shading indicates the inter-quartile range (middle 50% of                        studies).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0172342.g003: Absolute inequality between women and men in cataract surgical coverage (CSCpersons <6/60), and effective cataract surgical coverage (eCSCpersons <6/60) in 20 countries, 2005–2013. Absolute inequality is the difference between women and men (e.g. CSC in men–CSC in women); a positive value indicates women are worse off. Horizontal dashed lines and labels indicate the median values of all studies. Grey shading indicates the inter-quartile range (middle 50% of studies).
Mentions: Gender inequality was present for both CSC and eCSC. Despite large variation between countries, on average women were worse off than men for both indicators (Fig 3). Gender inequality remained after controlling for possible age differences between women and men—logistic regression showed women were more likely than men to have worse CSC (OR 1.3, 95%CI 1.1–1.6) and worse eCSC (OR 1.3, 95%CI 1.0–1.5). The average level of inequality in eCSC (median 4.6% IQR 0.5–7.1%) was slightly higher than CSC (median 2.3% IQR -1.5–11.6%).

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