Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma.

PURPOSE: To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. DESIGN: Retrospective chart review. PARTICIPANTS: One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. METHODS: Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. MAIN OUTCOME MEASURES: Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. RESULTS: The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. CONCLUSIONS: Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care.

Effect of water quality management efforts on wastewater loadings during the past century.

The history of wastewater discharges to the Hudson River watershed from Troy, New York, to the New York City Harbor was traced from 1900 to 2000. The parameters studied include population, flow, type of treatment, biochemical oxygen demand, suspended solids, total nitrogen, and total phosphorus. This paper details a methodology for estimating historic loadings where data are lacking. The data show dramatic changes in wastewater loadings. There has been a continued increase in wastewater flow and population over the past century but a decrease in contaminant loading during the last 25 years. The reduction in effluent loads is directly related to state and federal water quality management programs and the substantial public and private investment made in upgrading point source water pollution control infrastructure. A comparison of point with nonpoint source loads shows that although nonpoint sources are now a significant contributor of contaminants to the river, point sources remain as major sources of total nitrogen and total phosphorus.

Development of a quality improvement program in a department of ophthalmology.

OBJECTIVE: To design and implement a quality improvement (QI) programme in an academic department of ophthalmology. DESIGN: The six core competencies of the Accreditation Council for Graduate Medical Education serve as the model for this programme in an institutional practice. The authors review departmental rates of postoperative infections, unplanned reoperations, intraoperative complications, specific subspecialty postoperative complications and successes, and patient and staff compliments and complaints. RESULTS: The authors describe the structure and evolution of the QI programme in our ophthalmology department. CONCLUSIONS: It is possible to implement a structured QI programme in an academic department of ophthalmology. With healthcare oversight increasing, physician self-monitoring of quality of care measures will become even more important.