title: Comparison of resident and glaucoma faculty practice patterns in the care of open-angle glaucoma.
abstract: BACKGROUND
  Previous studies suggest there are large variations in adherence of ophthalmologists with the American Academy of Ophthalmology's Preferred Practice Patterns (PPPs). The purpose of this study was to compare rates of compliance with glaucoma care guidelines between resident and glaucoma faculty physicians at a single institution.
  
  
  METHODS
  Charts of resident continuity clinic or glaucoma faculty patients with primary open angle glaucoma (POAG), ocular hypertension (OHTN), or suspicion of glaucoma were reviewed during the 2005-6 academic year. Performance within care measures specified by the 2005 PPP guidelines was compared between resident and faculty physicians using univariate and multivariable logistic regression models.
  
  
  RESULTS
  112 resident and 100 faculty charts were reviewed. The mean compliance rate for all 7 care measures for resident physicians was significantly lower than that of faculty physicians (78% vs. 96%, p < 0.001). As compared to glaucoma faculty, resident physicians were less likely to have documented 6 of the 7 individual care measures (p ≤ 0.001 for all); the exception was optic nerve (ON) description. In multivariable analyses, resident patients were more likely to have at least one undocumented care measure than faculty patients (OR = 10.1, 95% CI = 5.1 to 20.0, p < 0.001). Among resident patients, undocumented care measures were more common among patients with poorer visual acuity (VA) in the better eye.
  
  
  CONCLUSIONS
  Though unmeasured differences in clinic structure and patient characteristics may have partially contributed to poorer resident performance, residents were more likely than faculty to omit PPP care measures and significantly underperformed faculty in global assessment of glaucoma care. Resident education should focus on integration of PPPs into residency training and monitoring of resident compliance with evidence-based guidelines.
authors: Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA. nzebard1@jhmi.edu.
authors: Nazlee
authors: N
authors: Zebardast
authors: Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA. jsolus@gmail.com.
authors: Jason F
authors: JF
authors: Solus
authors: Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA. hquigley@jhmi.edu.
authors: Harry A
authors: HA
authors: Quigley
authors: Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA. dsrikum1@jhmi.edu.
authors: Divya
authors: D
authors: Srikumaran
authors: Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA. pramulu@jhmi.edu.
authors: Pradeep Y
authors: PY
authors: Ramulu
mesh_terms: D000047:Academies and Institutes / Q000592:standards; D000368:Aged; D005180:Faculty, Medical / Q000706:statistics & numerical data*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000628:therapy*; D006068:Gonioscopy; D019983:Guideline Adherence; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014065:Tonometry, Ocular