title: Factors influencing the output of rural cataract surgical facilities in China: the SHARP study.
abstract: OBJECTIVE
  To identify factors associated prospectively with increased cataract surgical rate (CSR) in rural Chinese hospitals.
  
  
  METHODS
  Annual cataract surgical output was obtained at baseline and 24 months later from operating room records at 42 rural, county-level hospitals. Total local CSR (cases/million population/y), and proportion of CSR from hospital and local competitors were calculated from government records. Hospital administrators completed questionnaires providing demographic and professional information, and annual clinic and outreach screening volume. Independent cataract surgeons provided clinical information and videotapes of cases for grading by two masked experts using the Ophthalmology Surgical Competency Assessment Rubric (OSCAR). Uncorrected vision was recorded for 10 consecutive cataract cases at each facility, and 10 randomly-identified patients completed hospital satisfaction questionnaires. Total value of international nongovernmental development organization (INGDO) investment in the previous three years and demographic information on hospital catchment areas were obtained. Main outcome was 2-year percentage change in hospital CSR.
  
  
  RESULTS
  Among the 42 hospitals (median catchment population 530,000, median hospital CSR 643), 78.6% (33/42) were receiving INGDO support. Median change in hospital CSR (interquartile range) was 33.3% (-6.25%, 72.3%). Predictors of greater increase in CSR included higher INGDO investment (P = 0.02, simple model), reducing patient dissatisfaction (P = 0.03, simple model), and more outreach patient screening (P = 0.002, simple and multiple model).
  
  
  CONCLUSIONS
  Outreach cataract screening was the strongest predictor of increased surgical output. Government and INGDO investment in screening may be most likely to enhance output of county hospitals, a major goal of China's Blindness Prevention Plan.
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Tingting
authors: T
authors: Chen
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Ling
authors: L
authors: Jin
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Zhongqiang
authors: Z
authors: Zhou
authors: The Fred Hollows Foundation, China Program, China.
authors: Yiwen
authors: Y
authors: Huang
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Xixi
authors: X
authors: Yan
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Tianyu
authors: T
authors: Liu
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Ee Lin
authors: EL
authors: Ong
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Bin
authors: B
authors: Liu
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Wenyong
authors: W
authors: Huang
authors: The Fred Hollows Foundation, Sydney, Australia.
authors: Beatrice
authors: B
authors: Iezzi
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China Helen Keller International, New York, New York, United States.
authors: Mingguang
authors: M
authors: He
authors: Helen Keller International, New York, New York, United States Dana Center for Preventive Ophthalmology, Wilmer Eye Institute and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States.
authors: David S
authors: DS
authors: Friedman
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China ORBIS International, New York, New York, United States.
authors: Nathan G
authors: NG
authors: Congdon
mesh_terms: D000328:Adult; D002387:Cataract Extraction / Q000639:trends*; D002681:China; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires
keywords: China; cataract surgery; productivity; rural