title: Geographic Variation in the Use of Diagnostic Testing of Patients with Newly Diagnosed Open-Angle Glaucoma.
abstract: OBJECTIVE
  To determine the extent of geographic variation in the proportion of patients with newly diagnosed open-angle glaucoma (OAG) undergoing visual field (VF) testing, fundus photography (FP), and other ocular imaging (OOI) among patients residing in different US communities.
  
  
  METHODS
  Retrospective, longitudinal cohort study.
  
  
  METHODS
  All enrollees with newly diagnosed OAG enrolled in a managed care network between 2001 and 2014.
  
  
  METHODS
  We identified all persons in the plan with incident OAG residing in 201 communities across the United States. All communities contributed ≥20 enrollees. The proportion of enrollees undergoing ≥1 VF test, FP, OOI, and no testing of any type in the 2 years after first OAG diagnosis was determined for each community, and comparisons were made to assess the extent of variation in use of diagnostic testing among patients residing in the different communities.
  
  
  METHODS
  Receipt of VF testing, FP, OOI, or none of these tests in the 2 years after initial OAG diagnosis.
  
  
  RESULTS
  Of the 56675 enrollees with newly diagnosed OAG, the mean proportion of patients undergoing VF testing within 2 years of initial diagnosis was 74%±7%, ranging from as low as 51% in Rochester, Minnesota, to as high as 95% in Lancaster, Pennsylvania. The mean proportion undergoing OOI was 63%±10% and varied from 34% in Palm Springs/Rancho Mira, California, to 85% in Charleston, South Carolina. The mean proportion receiving FP was 26%±10% and ranged from as low as 3% in Fresno, California, to as high as 57% in Harlingen, Texas. The proportion undergoing no glaucoma testing ranged from 0% in Binghamton, New York, to as high as 35% in 2 other communities.
  
  
  CONCLUSIONS
  In many US communities, a high proportion of patients are undergoing testing according to established practice guidelines. However, in several communities, less than 60% of patients with newly diagnosed OAG are undergoing VF testing in the 2 years after initial OAG diagnosis, and in a few communities >1 in 4 patients have no record of glaucoma diagnostic testing of any type. Additional research is needed to understand factors driving this variation in practice patterns and its impact on patient outcomes.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Elam
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Blachley
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan. Electronic address: jdstein@med.umich.edu.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003941:Diagnostic Techniques, Ophthalmological / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005843:Geography; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000453:epidemiology*; D006068:Gonioscopy / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D010781:Photography / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D014481:United States; D058609:Visual Field Tests / Q000706:statistics & numerical data; D014794:Visual Fields