■有效和更新的临床指标可以作为评估和改善眼部护理的重要工具。
澳大利亚糖尿病眼部护理指标以前是根据2013年之前发布的指南制定的,然后通过全国性的患者记录卡审核(iCareTrack研究)来评估护理提供的适当性。为了反映新出现的证据和当代实践,本研究旨在更新澳大利亚2型糖尿病患者验光护理的临床指标.
■45个候选指标,包括现有的iCareTrack和从九项高质量的循证指南中得出的新指标,产生了。专家小组成员对影响进行了两轮修改的Delphi过程,可接受性,以及9分制指标的可行性,并投票赞成纳入或排除候选指标。当影响的中位数得分达到时,就包容性达成了共识,可接受性,可行性≥7,>75%的专家投票赞成纳入。
■32项临床指标可接受性较高,制定影响和可行性评级(所有中位数得分:9)。最终指标与历史记录相关(n=12),体检(n=8),召回期(n=5),转诊(n=5),和患者教育/沟通(n=2)。大多数(15个中的14个)iCareTrack指标保留了原始格式或进行了修改。新的指标包括记录糖尿病的类型,血脂水平,怀孕,全身用药,肾病,土著地位,全科医生详细信息,瞳孔检查,眼内压,光学相干层析成像,糖尿病视网膜病变分级,没有视网膜病变的高危糖尿病患者的召回期,高危增生性视网膜病变的转诊,与全科医生沟通,和病人的教育。
■根据当代证据和专家共识,开发了一组32项更新的糖尿病眼部护理临床指标。这些更新的指标为澳大利亚糖尿病患者评估和加强眼部护理计划的制定提供了信息。
UNASSIGNED: Valid and updated clinical indicators can serve as important tools in assessing and improving eyecare delivery.
UNASSIGNED: Indicators for diabetic eyecare in Australia were previously developed from guidelines published before 2013 and then used to assess the appropriateness of care delivery through a nationwide patient record card audit (the iCareTrack
study). To reflect emerging evidence and contemporary practice, this
study aimed to update clinical indicators for optometric care for people with type 2 diabetes in Australia.
UNASSIGNED: Forty-five candidate indicators, including existing iCareTrack and new indicators derived from nine high-quality evidence-based guidelines, were generated. A two-round modified Delphi process where expert panel members rated the impact, acceptability, and feasibility of the indicators on a 9-point scale and voted for inclusion or exclusion of the candidate indicators was used. Consensus on inclusion was reached when the median scores for impact, acceptability, and feasibility were ≥7 and >75% of experts voted for inclusion.
UNASSIGNED: Thirty-two clinical indicators with high acceptability, impact and feasibility ratings (all median scores: 9) were developed. The final indicators were related to history taking (n = 12), physical examination (n = 8), recall period (n = 5), referral (n = 5), and patient education/communication (n = 2). Most (14 of 15) iCareTrack indicators were retained either in the original format or with modifications. New indicators included documenting the type of diabetes, serum lipid level, pregnancy, systemic medications, nephropathy, Indigenous status, general practitioner details, pupil examination, intraocular pressure, optical coherence tomography, diabetic retinopathy grading, recall period for high-risk diabetic patients without retinopathy, referral of high-risk proliferative retinopathy, communication with the general practitioner, and patient education.
UNASSIGNED: A set of 32 updated diabetic eyecare clinical indicators was developed based on contemporary evidence and expert consensus. These updated indicators inform the development of programs to assess and enhance the eyecare delivery for people with diabetes in Australia.