title: Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Duke-NUS Graduate Medical School, Singapore, Republic of Singapore.
authors.forename: Sally S
authors.initials: SS
authors.lastname: Ong
authors.affiliation: Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Eye Centers of Racine and Kenosha, Racine, Wisconsin.
authors.forename: Krishna
authors.initials: K
authors.lastname: Sanka
authors.affiliation: Duke Eye Center, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Priyatham S
authors.initials: PS
authors.lastname: Mettu
authors.affiliation: Brosnan Eye Associates, Asheville, North Carolina.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Brosnan
authors.affiliation: Duke Eye Center, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Stinnett
authors.affiliation: W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.affiliation: Duke Eye Center, Duke University School of Medicine, Durham, North Carolina. Electronic address: pratap.challa@duke.edu.
authors.forename: Pratap
authors.initials: P
authors.lastname: Challa
mesh_terms: D000047:Academies and Institutes / Q000592:standards; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000628:therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D009885:Ophthalmology / Q000193:education / Q000592:standards*; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012955:Societies, Medical / Q000592:standards; D014481:United States