title: Interhospital variation in appropriateness of cataract surgery.
abstract: OBJECTIVE
  The aim of this study was to analyse the inter-hospital variation in the appropriateness of cataract phacoemulsification in Spain.
  
  
  METHODS
  This observational, multicentre, prospective study involved patients aged 18-90 years. Each phacoemulsification intervention was classified as 'necessary', 'appropriate', 'uncertain' or 'inappropriate' according to explicit appropriateness criteria previously established using the RAND/UCLA methodology. A descriptive statistical analysis was performed, followed by univariate and multivariate logistic regression analysis, in order to examine the differences between hospitals.
  
  
  RESULTS
  In total, 5063 patients from 15 hospitals were enrolled. The percentage of patients in each hospital who inappropriately underwent phacoemulsification varied from 1.2% to 24.0% (P < 0.0001). The most common inappropriate scenario was that of patients with a simple, unilateral cataract with no limitation of their visual function, with a pre-surgery visual acuity of ≥ 0.5 in both eyes, and for whom surgical correction would involve low technical complexity.
  
  
  CONCLUSIONS
  The variation in appropriateness of phacoemulsification cannot be attributed solely to the clinical differences between the hospitals' patients. There is room for improvement in the appropriate indication of phacoemulsification. Measures based on the dissemination of appropriateness criteria might improve quality of care.
authors.affiliation: Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, C/Gran Vía, Madrid, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Llorente
authors.forename: Juan A
authors.initials: JA
authors.lastname: Blasco
authors.forename: José M
authors.initials: JM
authors.lastname: Quintana
authors.forename: Amaia
authors.initials: A
authors.lastname: Bilbao
authors.forename: Txomin
authors.initials: T
authors.lastname: Alberdi
authors.forename: Juan R
authors.initials: JR
authors.lastname: Lacalle
authors.forename: José M
authors.initials: JM
authors.lastname: Begiristain
authors.forename: Marisa
authors.initials: M
authors.lastname: Baré
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D009885:Ophthalmology; D018918:Phacoemulsification / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D013030:Spain; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D055815:Young Adult