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French centres adopt ICHOM standards

Standards to be tested over four years to evaluate patient outcomes

Dermot McGrath

Posted: Sunday, September 1, 2019

With national health authorities, payers and other stakeholders placing ever-greater emphasis on quality control and value-based healthcare, French cataract surgeons may be forced sooner rather than later to introduce objective benchmarking and quality control measures into their practices, according to Francois Lignereux MD.

“Cataract is the most commonly performed surgical procedure in France, with increasing demand from health authorities to quantify the value of the operation to the patient. Certain countries such as Belgium, Sweden and the Netherlands already have a national cataract registry based on patient-reported outcomes, so we can eventually expect to see this evolution as well in France,” he told delegates attending the annual congress of the French Implant and Refractive Surgery Association (SAFIR) in Paris, France.

Dr Lignereux said that three French ophthalmic centres – Institut Ophtalmologique Sourdille Atlantique, University Hospital in Nantes and Chénieux Ophtalmologie at Polyclinique de Limoges – have recently adopted the standard set for cataract surgery developed by the International Consortium for Health Outcomes Measurement (ICHOM). Between the three centres, more than 40 practitioners carry out around 15,000 surgeries every year. Medical teams are now able to share and compare patients’ average clinical benefit through a digital platform managed by a non-profit organisation acting as a trusted third party – the Consortium VBHC France – founded by Prof Gregory Katz.

On a national level, there is a clear need for more robust outcomes measures and registry data. An estimated 880,000 patients undergo cataract operations in France every year, with a variation of cataract surgeries per capita that nearly doubles depending on French regions.

The ICHOM standard sets are standardised outcomes, measurement tools and time points and risk adjustment factors for a given condition, which were developed to capture the outcomes of care for costly conditions.

Dr Lignereux explained that the cataract standard set uses the Catquest-9SF patient questionnaire for patient-reported outcome measures (PROM), which was originally developed by Prof Mats Lundström, founder of the EUREQUO registry developed by ESCRS.

The Catquest-9SF measures visual disability on an interval scale and contains nine questions (items); two global items and seven difficulty items. It has been shown to demonstrate robust psychometric properties and has also been selected as the instrument of choice in the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) database for the assessment of cataract outcomes.

The questionnaire is easily administered and rapidly completed by the patient, said
Dr Lignereux.

“In the clinic, the secretary attributes a printed QR code to the patient who then goes to the waiting room and uses the QR code to access the questionnaire on a computer tablet. The patient gives consent to participate in the questionnaire and then answers the questions. The responses are automatically recorded in the patient’s electronic medical record,” he said.

Overall, the ICHOM methodology should allow surgeons to objectively measure the value of the healthcare they provide to their patients, and is well suited for use in daily clinical practice, he concluded.

Francois Lignereux: francois.lignereux@free.fr