[When is the Damage to the Eye to be Assessed as Corresponding to a 25 % Reduction in Earning Ability?]. / Wann ist der Schaden eines Auges über 25 % Minderung der Erwerbsfähigkeit anzusetzen?

In General Accident Insurance, loss of sight in one eye is assessed as giving a 25 % reduction in earning capacity. This does not exclude the possibility that a greater reduction in earning capacity can be assessed for this eye. The ophthalmological situation is outlined under which a much greater reduction in earning capacity can be assessed, if there is not misassessment.

A proposed method for retrospective eye dose assessments for the purposes of resolving cataract compensation claims.

The 2011 International Commission on Radiological Protection (ICRP) statement on tissue reactions suggested a significant reduction in the threshold dose for radiation induced cataracts. This, combined with the potential for a long delay between exposure and cataract diagnosis, may result in an increased requirement to evaluate eye dose from past exposures in order to settle current compensation claims. This article highlights how compensation claims relating to radiation exposure are assessed within the UK legal system and suggests that in vivo Electro Paramagnetic Resonance (EPR) dosimetry of teeth has utility for the retrospective quantification of radiation doses to the eye. It was identified that in vivo EPR in its current form may be sufficiently sensitive to support cataract compensation claims, although further work is required to enable appropriate dose conversion coefficients to be quantified.

Impact of hospital volume and specialization on the cost of orbital trauma care.

PURPOSE: To examine the impact of hospital volume and specialization on the cost of orbital trauma care. DESIGN: Comparative case series and database study. PARTICIPANTS: Four hundred ninety-nine patients who underwent orbital reconstruction at either a high-volume regional eye trauma center, its academic parent institution, or all other hospitals in Maryland between 2004 and 2009. METHODS: We used a publicly available database of hospital discharge data to identify the study population's clinical and cost characteristics. Multivariate models were developed to determine the impact of care setting on hospital costs while controlling for patient demographic and clinical variables. MAIN OUTCOME MEASURES: Mean hospital costs accrued during hospital admission for orbital reconstruction in 3 separate care settings. RESULTS: Almost half (n = 248) of all patients received surgical care at the regional eye trauma center and had significantly lower adjusted mean hospital costs ($6194; 95% confidence interval [CI], $5709-$6719) compared with its parent institution ($8642; 95% CI, $7850-$9514) and all other hospitals ($12,692; 95% CI, $11,467-$14,047). A subpopulation analysis selecting patients with low comorbidity scores also was performed. The eye trauma center continued to have lower adjusted costs ($4277; 95% CI, $4112-$4449) relative to its parent institution ($6595; 95% CI, $5838-$7451) and other hospitals ($7150; 95% CI, $5969-$8565). CONCLUSIONS: Higher volume and specialization seen at a regional eye trauma center are associated with lower costs in the surgical management of orbital trauma.

The Cost of Hospitalized Ocular Injuries in Texas, 2013-2014.

PURPOSE: Healthcare costs are a continual concern. To improve our cost-efficiency we must identify the direct costs of ocular injuries requiring hospitalization. The purpose of this study was to evaluate the direct costs of hospitalized ocular injuries in Texas. METHODS: Retrospective cohort study using the Texas Hospital Inpatient Discharge Public Use Data File, 2013-2014. Persons hospitalized for ocular trauma were identified using ICD-9-CM codes. Injuries were subcategorized as ocular adnexal, open globe, or closed globe based on diagnosis and procedure codes and analyzed across three age groups: 18-44, 45-64, and >65 years. RESULTS: From 2013 to 2014, 1498 patients were hospitalized with ocular adnexal injuries, 644 with open globe injuries, and 2877 with closed globe injuries. Length of stay ranged from 2 to 4 days. The median total charges ranged between $34,576 and $55,409 across all injuries and groups. The largest portion of medical costs were due to radiology in the ocular adnexal and closed globe groups, and operating room charges in the open globe group. CONCLUSIONS: Median hospitalization costs for ocular injuries were between $34,576 and $55,409 for a 2-4 day length of stay. Open globe injuries had the shortest median lengths of stay, 2-3 days, and lower median total costs. Only in the open globe group were operative costs higher than radiology costs. Operative charges were lowest in the oldest age group, who also had longer lengths of stay. Our reported costs were lower than other nationally reported ocular injury costs for similar lengths of hospital stay.

Characteristics of Open Globe Injuries in the United States From 2006 to 2014.

Importance: Open globe injuries can lead to substantial visual morbidity and lifelong sequelae. Interventions to reduce the burden of open globe injuries in the United States require a better understanding of these injuries through well-designed epidemiologic investigations. Objective: To examine the incidence, common injury mechanisms, and economic burden of open globe injuries in the United States. Design, Setting, and Participants: This retrospective, cross-sectional study of US nationwide emergency department (ED) data assessed all ED visits of patients with a primary diagnosis of open globe injury in the Nationwide Emergency Department Sample (NEDS) from January 1, 2006, to December 31, 2014. Data analysis was performed from August 29, 2018, to November 11, 2019. Main Outcomes and Measures: Annual incidence of open globe injuries by age, sex, mechanism of injury, and concomitant diagnosis, as well as median charges associated with open globe injuries and variables associated with hospitalization. Results: A total of 124 989 ED visits for open globe injuries were assessed, with an incidence of 4.49 per 100 000 population in the United States from 2006 to 2014 (mean [SD] age of study participants, 37.7 [22.5] years; 94 078 [75.3%] male). The incidence was highest in 2006 (5.88 per 100 000 population) and decreased by 0.3% per month between 2006 and 2014 (incidence rate ratio, 0.99; 95% CI, 0.99-0.99; P < .001). Open globe injuries occurred in 37 060 individuals (30.6%) of low socioeconomic status. The most common injury mechanism was being struck by or against an object or person (40 119 of all 124 989 injury mechanisms [32.1%]). Open globe injuries associated with falls increased 6.6% between 2006-2010 and 2011-2015 (95% CI, 1.04-1.08; P < .001) and were the most common injury mechanism in individuals older than 70 years. The total cost associated with open globe injuries was $793 million. The cost of ED visits increased from $865 during 2006-2010 to $1557 during 2011-2015. Inpatient costs similarly increased from $21 527 during 2006-2010 to $30 243 during 2011-2015. Conclusions and Relevance: The incidence of open globe injuries in the United States decreased from 2006 to 2014. Although the data are from 5 to 13 years ago, these findings appear to provide valuable information for targeting preventive measures toward individuals at highest risk; targeting young men with lower socioeconomic status and individuals 70 years or older at an increased risk of falls may help lower the incidence of open globe injuries.

Occupational eye injury and risk reduction: Kentucky workers' compensation claim analysis 1994-2003.

BACKGROUND: Occupational eye injuries are a significant source of injury in the workplace. Little population-based research in the area has been conducted, and is necessary for developing and prioritizing effective interventions. METHODS: Workers' compensation data from the state of Kentucky for the years 1994-2003 were analysed by demographics, injury nature and cause, cost, and occupational and industrial characteristics. The US Bureau of Labor Statistics' Current Population Survey was utilised to compute injury rates for demographic and occupational groups. RESULTS: There were 10,545 claims of ocular injury, representing 6.29 claims per 10,000 workers on average annually. A substantial drop in the claim rate was found after the state passed monetary penalties for injuries caused by employer negligence or OSHA violations. Claims by men were over three times more likely than those by women to have associated claim costs (OR 0.52; 95% CI 0.32 to 0.85; p = 0.009). The highest eye injury rates per 10,000 of 13.46 (95% CI 12.86 to 14.07) were found for the helpers/labourers occupation, and of 19.95 (95% CI 18.73 to 21.17) for the construction industry. The total cost of claim payments over the period was over $3,480,000, and average cost per claim approximated $331. CONCLUSIONS: Eye injuries remain a significant risk to worker health, especially among men in jobs requiring intensive manual labour. Evidence showed that increased legislative regulation led to a decline in eye injuries, which was consistent with other recent findings in the area. Additionally, targeting groups most at risk, increasing worker training, providing effective eye protection equipment, and developing workplace safety cultures may together reduce occupational eye injuries.

Trends and Disparities in Inpatient Costs for Eye Trauma in the United States (2001-2014).

PURPOSE: To determine the trends and disparities in inpatient costs for eye trauma in the United States from 2001 through 2014. DESIGN: Retrospective population-based cross-sectional study. METHODS: National Inpatient Sample, a representative sample of U.S. hospital discharges, was used to determine costs of eye trauma hospitalizations. Linear regression was used to estimate changes in mean inflation-adjusted cost per admission. Multivariable logistic regression was used to evaluate factors associated with a cost in the highest quartile (>$13 000) including age, sex, race, income quartile, primary payer, hospital location, size, and type. The model was adjusted for year of admission, length of stay, type of trauma, comorbidities, and the type and number of procedures performed. RESULTS: The inpatient costs for eye trauma from 2001 through 2014 totaled $1.72 billion. The mean cost (95% confidence interval [CI]) per stay remained relatively constant: $12 000 ($11 000-13 000) in 2001 to $11 000 ($10 000-12 000) in 2014 (P = .643). A cost in the highest quartile was more likely in African Americans compared to whites (adjusted odds ratio, 1.3; 95% CI, 1.2-1.5), patients in the highest income quartile compared to those in the lowest (1.3; 1.2-1.5), uninsured patients compared to publicly insured patients (1.2; 1.1-1.4), teaching hospitals compared to non-teaching ones (1.5; 1.2-1.8), and the West compared to the South (2.4; 2.0-2.8). CONCLUSIONS: Inpatient costs of eye trauma have remained steady and can be potentially reduced by addressing associated disparities. Further research including outpatient costs and eye trauma in vulnerable populations will be key to optimizing care and advancing healthcare equity.

Cost of Military Eye Injury and Vision Impairment Related to Traumatic Brain Injury: 2001-2017.

INTRODUCTION: Annual incidence of eye injury among members of the US armed services is high and can cause vision impairment and blindness. Traumatic brain injury is also associated with visual function. An estimate of the cost of treatment, benefits for those who are disabled, productivity loss for those with reduced vision function, and the cost of replacing and retraining others to take the responsibility of those who are discharged from the military will provide a benchmark to which to compare the cost of new methods to prevent, diagnose, mitigate, treat, and rehabilitate vision loss after injury. MATERIALS AND METHODS: The modeling exercise used a combination of data from military websites, results previously published in the literature, and from other government websites. Data were combined to estimate the number of superficial injuries, the number of injuries with a high risk of blindness, the cost of medical care, the cost of disability benefits, and the cost of potential lost productivity. RESULTS: Over the time period in question, the average annual incidence of eye injury was 15,681 with 304 hospitalized and 298 at high risk of blindness. There were 4,394 annual TBI cases without injury to the eye but with visual impairment. The total cost of treatment, benefits, and potential lost productivity is $2.4 billion annually; $1.9 billion is associated with TBI. $11.7 million is associated with replacing and retraining members of the military. CONCLUSIONS: The cost of eye injury and vision dysfunction in the military is substantial. The cost of potential productivity loss associated with TBI makes up the largest proportion of total costs. Developing new standards to enhance eye safety and limit TBI could be cost-effective. Cost analyses such as this study should prove helpful in determining the economic return on investments to prevent, mitigate, treat, and rehabilitate visual system injury.

Trends in Eye Injuries and Associated Medical Costs among Children in the United States, 2002-2014.

PURPOSE: To describe the trends in eye injuries and associated medical costs among children in the United States. METHODS: Data were from the 2002-2014 Medical Expenditure Panel Survey (MEPS). Eye injuries in children aged <18 years were identified by the International Classification of Diseases-9 (ICD-9) codes. The trends of cumulative incidence of eye injury, total costs, and average costs were estimated from 2002-2014 MEPS data. All costs were adjusted to 2014 US dollars. Analyses accounted for the complex stratified multistage survey design of the MEPS. We used MarketScan data (2010-2013) to validate outpatient cost estimates. RESULTS: The 3-year average cumulative incidence of eye injuries declined from 0.56% in 2002-2004 to 0.31% in 2012-2014 (Trend p < 0.001). The average annual total costs decreased from $193 million during 2002-2004 to $66 million during 2012-2014 (p < 0.001). CONCLUSION: The MEPS data showed that among children aged <18 years, the incidence of eye injuries and associated financial burden substantially declined during 2002-2014, highlighting the progress in preventing children eye injuries. Continuing efforts are needed to further reduce the burden in this population.

Hospitalized ocular injuries among persons with low socioeconomic status: a medicaid enrollees-based study.

PURPOSE: To investigate the incidence of hospitalized ocular injuries by sociodemographic characteristics and type of ocular injury. METHODS: Using 1996-1998 Michigan State Medicaid Research Files, ocular injuries were identified by the recorded principal or secondary diagnosis code of International Classification of Diseases, Ninth Revision, Clinical Modification. We excluded persons enrolled in both Medicaid and Medicare and we adjusted for Medicaid enrollment turnover and for repeat admission for the same ocular injury. We calculated overall incidence of hospitalized ocular injuries, relative risk (RR), and associated 95% confidence intervals (95% CI) of injuries by sociodemographic characteristics and by major types of ocular injury. RESULTS: The average annual incidence of hospitalization for ocular injury was 12.00 per 100,000 full-year-equivalent Michigan Medicaid enrollees. Males had a higher incidence and RR than females (17.3 per 100,000 males vs. 8.1 per 100,000 females; RR = 2.13, 95% CI: 1.70-2.66). The incidence of hospitalized ocular injuries increased with increasing age of the Medicaid enrollee. Disabled individuals had a lower incidence of hospitalized ocular injuries than cash recipients and the medically needy (7.8 per 100,000 disabled enrollees vs. 28.6 per 100,000 cash recipients and 25.7 per 100,000 medically needy enrollees). The three leading types of hospitalized ocular injuries were orbital floor fracture; open wound of eyeball; and open wound of ocular adnexa. The major types of hospitalizations for ocular injury differed significantly by Medicaid eligibility group. CONCLUSIONS: Medicaid enrollees represent a unique subgroup of the U.S. population and their rate of hospitalization for ocular injury is significant. Sociodemographic characteristics, including gender, age, and Medicaid eligibility group, need to be taken into consideration when developing appropriate eye injury prevention initiatives.

Adjunctive intraocular and peri-ocular steroid (triamcinolone acetonide) versus standard treatment in eyes undergoing vitreoretinal surgery for open globe trauma (ASCOT): study protocol for a phase III, multi-centre, double-masked randomised controlled trial.

BACKGROUND: Eyes sustaining open globe trauma are at high risk of severe visual impairment. Ocular injuries which result in visual loss invariably affect the posterior segment of the eye, and prevention of visual loss involves posterior segment (vitreoretinal) surgery. Despite improvements in vitreoretinal surgical techniques, outcomes in these patients remain unsatisfactory, and development of the intraocular scarring response proliferative vitreoretinopathy is the leading cause. Proliferative vitreoretinopathy is the most common cause of recurrent retinal detachment in these eyes; it is reported to occur in up to 45 % of cases. METHODS/DESIGN: The Adjunctive Steroid Combination in Ocular Trauma (ASCOT) trial is a multi-centre, double-masked, parallel-arm randomised controlled trial with an internal pilot designed to investigate the effectiveness and cost-effectiveness of using intravitreal and sub-Tenon's triamcinolone acetonide peri-operatively in patients undergoing vitrectomy following open globe trauma. In total, 300 eyes of 300 patients will be recruited and randomly allocated to one of two treatment groups. Both groups will receive standard surgical treatment and routine pre-operative and post-operative treatment and care. The treatment group will receive an adjunctive peri-operative steroid combination (triamcinolone acetonide) consisting of 4 mg/0.1 ml into the vitreous cavity and 40 mg/1 ml into the sub-Tenon's space. The trial incorporates a two-stage internal pilot to examine projected recruitment and retention rates. Progression criteria from the internal pilot study will enable us to determine whether to undertake the main trial. Patients and primary outcome assessors will be masked to treatment allocation. The primary outcome will be an improvement from baseline to 6 months of at least 10 on the corrected visual acuity as measured by ETDRS letter score. Secondary outcomes will be development of scarring, retinal detachment, intraocular pressure abnormalities, quality of life and public sector service use. DISCUSSION: This is the first powered, controlled clinical trial to investigate the use of adjunctive triamcinolone in patients undergoing vitrectomy following open globe trauma. TRIAL REGISTRATION: EudraCT2014-002193-37 . Registered on 5 September 2014. ISRCTN30012492 . Registered on 5 September 2014.

Cost analysis of military eye injuries in fiscal years 1988-1998.

Army, Navy, and Air Force safety center ground eye injuries were evaluated from fiscal year 1988 through fiscal year 1998. The U.S. Army Safety Center data revealed that the average Army military eye injury mishap caused a loss of 6.1 days from work, at a cost averaging 9724 dollars. The U.S. Navy Safety Center data showed that the average Navy military eye injury mishap caused a loss of 5.9 days from work, at a cost averaging 4222 dollars. The Air Force Safety Center data revealed that the average Air Force eye injury mishap caused a loss of 4.7 days from work, at a cost averaging 3196 dollars. Comparing safety center data with Defense Medical Surveillance System data exposed an underreporting of safety center data by at least 250%. To improve accurate meaningful data collection, an automated eye injury collection system should be initiated.

Economic antecedents of temporal variation in the incidence of ocular trauma.

PURPOSE: To test the reciprocal risk hypothesis that the monthly number of unemployed persons in Alabama predicts: 1) the odds that a worker will suffer an ocular injury; and 2) the incidence of ocular injuries at home. METHODS: Data from the United States Eye Injury Registry and from the Bureau of Labor Statistics are analyzed with time series methods to test the hypotheses. RESULTS: As implied by the reciprocal risk hypothesis, the monthly odds of a worker reporting a job-related ocular injury decrease as the number of unemployed persons increases. The incidence of ocular injuries in the home, however, increases when the number of unemployed persons increases. CONCLUSIONS: Consistent with theory and earlier research, the incidence of ocular injuries appears related to the performance of the economy. Unlike earlier research, however, we find a reciprocal risk between injuries at work and home. The findings suggest that public health efforts to prevent injuries could be made more effective by strategically shifting the focus from home to work and vice versa depending on changes in the local economy.

Epidemiology of compensable work-related ocular injuries and illnesses: incidence and risk factors.

Incidence rates of work-related compensable ocular injuries/illnesses and associated risk factors were estimated by using a state-managed workers' compensation database. The annual incidence rate was estimated to be 537 per 100,000 employees. The majority of the ocular injuries and illnesses resulted from foreign bodies in the external eye (incidence rate 194 per 100,000 employees). Incidence rates for superficial eye injury, atopic conjunctivitis, burn, keratitis, chronic conjunctivitis, and contusion were 168.3, 30.9, 28.0, 23.4, 17.9, and 15.3 per 100,000 employees, respectively. The highest incidence rate was observed in the agricultural sector, with male employees having higher rates than female employees. Cooks, housekeepers, and food service workers had higher risk of atopic conjunctivitis (relative risk, 3.2 to 7.3) compared with other workers. The majority of the atopic conjunctivitis illnesses and burn injuries were associated with chemical exposures. Reduction of exposures and targeted intervention among high-risk workers should reduce the incidence of work-related ocular injuries and illnesses.

Eye injuries in indoor cricket at Wellington Hospital: a survey January 1987 to June 1989.

About 30% of all sports injuries to the eye seen at Wellington Hospital are due to indoor cricket. An analysis of 29 eye injuries, January 1987 to June 1989 was carried out. Traumatic iritis, mydriasis and commotio retinae were the common injuries. There were eight blow out fractures of the orbit. Only two patients had permanent loss of vision due to choroidal tears with best vision in the damaged eye reduced to 6/9. A total of 88 eye clinic visits and 24 inpatient days were involved. The incidence of these injuries could be reduced by wearing eye and/or facial protection.

Serious eye injury from windscreen contact.

A retrospective survey was carried out of serious eye injury caused by windscreen contact in road traffic accidents over a 6-year period. All 15 patients had contacted toughened windscreens, and all but one did not wear seat belts. The cost in terms of pounds sterling paid out by the National Health Service, and also the cost in terms of visual handicap were assessed. It was found that of the 15 patients admitted during this time, the treatment of the large majority cost at least twice as much as that for patients undergoing routine cataract surgery. This was primarily due to the longer hospitalization necessary. Only 2 patients retained a visual acuity of 6/6.

Impact of visors on eye and orbital injuries in the National Hockey League.

OBJECTIVE: Eye and orbital injuries are a significant risk to professional hockey league players and have resulted in career-ending injuries. The goal of this study was to determine the incidence, value lost, mechanism, and effect of visors on eye and orbital injuries over the last 10 National Hockey League (NHL) seasons: 2002-2003 to 2012-2013. DESIGN: Retrospective case-control study. PARTICIPANTS: Participants were 8741 NHL players who had played at least 1 game during the last 10 seasons. METHODS: Using The Sports Network (TSN), ProSportsTransactions, and the Sporting News Hockey Register, NHL players were searched to identify eye and orbital injuries. The mechanism of injury was obtained from media reports and direct observation from online videos. The number of players wearing visors each year was obtained from The Hockey News annual visor survey. RESULTS: A total of 149 eye or orbital injuries over the last 10 seasons resulted in an overall incidence of 2.48 per 10 000 athlete exposures. A total of 1120 missed games led to a lost financial value of more than $33 million. Visor use among players grew from 32% in 2002-2003 to 73% in 2012-2013, and there was a significantly increased risk for having an eye or orbital injury when a visor was not worn (OR 4.23, 95% CI 2.84-6.30). Most injuries were a result of being hit by a deflected or direct puck (37%) followed by being struck by a high stick (28%). Players who did not wear a visor were found to be involved in more fights, hits, and penalty minutes (p < 0.001). CONCLUSIONS: Eye and orbital injuries are mostly accidental in nature and represent a significant risk and cost to the NHL and its players. Eye and orbital injuries are significantly more likely in players who do not wear visors.

Survivors of self-inflicted gunshot wounds to the head: characterization of ocular injuries and health care costs.

IMPORTANCE: Suicides and attempted suicides are major public health issues in the United States and around the world. Self-inflicted gunshot wounds (SIGSWs) are a common method of attempting suicide, the head being the most commonly injured body region; however, the literature lacks an overview of the orbital and ocular injuries as well as outcomes associated with SIGSWs. OBJECTIVES: To characterize the ocular and orbital injuries and outcomes of patients presenting with SIGSWs and to examine the cost associated with these injuries. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review was performed of all patients who presented to the University of Iowa Hospitals and Clinics between 2003 to 2013 with the admitting diagnosis of self-inflicted injuries via firearms. Patients with no periorbital or ocular injuries and/or those who did not survive for at least 2 months following the incident were excluded. MAIN OUTCOMES AND MEASURES: Ocular injuries and outcomes and health care costs and reimbursements, which were generated by a financial report obtained from the hospital finance department that included data from both the hospital billing and cost accounting systems. RESULTS: All patients in this study (n = 18) were men with a mean age of 47.2 years. Eight patients (44.4%) displayed submental missile entry points, 7 (38.9%) displayed intraoral entry points, and 3 (16.7%) displayed pericranial entry points. Patients with pericranial entries sustained more severe ocular injuries and had poorer ocular outcomes. Seven patients (38.9%) were found at final follow-up to have visual acuity of 20/40 or better in each eye and all showed missile trajectories in the sagittal plane. The mean cost of treatment of these patients totaled $117,338 while the mean reimbursement amount was $124,388. CONCLUSIONS AND RELEVANCE: Data regarding ocular injuries and outcomes may assist ophthalmologists in the treatment of patients with SIGSWs in the future. Many patients had extremely functional vision at final follow-ups, which highlights the importance of specialists conducting examinations and reconstructive procedures promptly, carefully, and thoroughly. Cost and reimbursement data suggest that while these cases place a large financial burden on society, they may not burden hospital systems in the same way.

Increasing compliance with protective eyewear to reduce ocular injuries in stone-quarry workers in Tamil Nadu, India: a pragmatic, cluster randomised trial of a single education session versus an enhanced education package delivered over six months.

OBJECTIVE: To evaluate the efficacy of standard education versus enhanced education in increasing compliance with protective eyewear to prevent ocular injuries in stone-quarry workers. DESIGN: Pragmatic, allocation concealed, participant and outcome assessor blinded, cluster randomised trial. SETTING: Six stone-quarries around Vellore, Tamil Nadu, South India. PARTICIPANTS: 204 consenting adult stone quarry workers. INTERVENTIONS: Protective eyewear plus enhanced education (one education session, plus 11 sessions of group education, individual discussions, and educational plays over six months) versus protective eyewear plus standard education (one education session and 5 follow up visits). OUTCOMES: The primary outcomes were observer-rated compliance with protective eyewear and reduction in incidence of ocular injuries (slit-lamp examination by an observer blinded to allocation status) at three and six months. Analysis was by intention to treat. RESULTS: Quarries and participants were similar at enrolment. All quarries; 92/103 (90%) of workers in three quarries given enhanced intervention, and 91/101 workers (89%) in three quarries given standard education, completed six months follow up. Compared to standard education, enhanced education significantly increased compliance with protective eyewear by 16% (95% CI 3-28%) at three months (OR 2.1; 95% CI 1.2-3.8); and by 25% (95% CI 11-35%) at six months (OR 2.7; 95% CI 1.5-4.8). Protective eyewear and enhanced education reduced the incidence of eye injuries at three months by 16% (95% CI 7-24%); and standard education by 13% (95% CI 4-22%), compared to the three months before interventions. The cumulative reduction over baseline in eye injuries at the six months was greater with enhanced education (12% decrease; 95% CI 3-21%) than with standard education (7% decrease; 95% CI 17% decrease to 3% increase). However, this incidence did not differ significantly between intervention arms at three months (OR 0.7% 95% CI 0.3-2.1); and at six months (OR 0.8; 95% CI 0.4-1.5). CONCLUSION: Provision of appropriate protective eyewear reduces the incidence of eye injuries in stone-quarry workers. Periodic educational and motivational sessions with individuals and groups facilitates sustained use of protective eyewear.

[Heterogeneity of costs and performance for penetrating eye injuries and suturing amniotic membranes under DRG conditions : Analysis of case constellations of the G-DRG C01B of the Regensburg University eye clinic]. / Kosten- und Leistungsheterogenität bei penetrierenden Augenverletzungen und Amnionmembranaufnähungen unter DRG-Bedingungen : Analyse von Fallkonstellationen der G-DRG C01B der Universitätsaugenklinik Regensburg.

BACKGROUND: Patients with penetrating eye injuries are a very heterogeneous group both medically and economically. Since 2009, treatment involving sutures for open eye injuries and cases requiring amniotic membrane transplantation (AMT) were allocated to DRG C01B of the German diagnosis-related group system. However, given the significant clinical differences between these treatments, an inhomogeneity of costs to performance is postulated. This analysis describes case allocation problems within the G-DRG C01B category and presents solutions. METHODS: A retrospective analysis was conducted from the standardized G-DRG data of 277 patients with open eye injuries and AMT between 2007 and 2008, grouped under the 2008 G-DRG system version to the G-DRG C01Z category. This data was provided by the Department of Ophthalmology at the University Hospital Regensburg. Additionally case-based data of the following were supplemented: length of surgery, time of anesthesia and intensity of patient care. Fixed and variable costs were determined for surgery and other inpatient treatment. Finally, an analysis of the heterogeneity of costs within the G-DRG C01B of the G-DRG system 2009 was implemented. RESULTS: Inhomogeneity was evident within the G-DRG C01B of the G-DRG system 2009 for the two groups suture of open eye injuries and AMT concerning the parameters length of stay, proportion of high outliers and cost per case. Multiple surgeries during an inpatient stay lead to an extended length of stay and increasing costs, especially within the AMT group. Intensity of patient care and the consideration of patient comorbidity did not yield relevant differences. CONCLUSION: The quality of the G-DRG system is measured by its ability to obtain adequate funding for highly complex and heterogeneous cases. Specific modifications of the G-DRG structures could increase the appropriateness of case allocation for patients with open eye injuries within the G-DRG C01B of the German DRG system 2009. As a result of the present study, cases with amniotic membrane transplantation should not be allocated to the G-DRG C01B. A petition has been presented by the German Association of Ophthalmology (DOG) to the German DRG Institute to restructure the G-DRG C01B. Data-based analysis is an essential prerequisite for a constructive development of the G-DRG system and a necessary tool for the active participation of medical societies in this process.