title: Eye Care Productivity and Access in the Veterans Affairs Health Care System.
abstract: Eye care in the Veterans Affairs Health Care System is challenged with increasing demand and higher prevalence of patients with complex ocular conditions. Understanding factors that impact eye care productivity and access is necessary for appropriate allocation of resources. The purpose of this study was to determine the impact of various eye clinic personnel on eye care provider productivity and patient access.
  
  
  
  Utilizing data from the Veterans Health Administration National Data Warehouse, workload and level of staffing were analyzed. Trends in the data were analyzed using descriptive and regression analyses employing both linear and curve fitting modeling methods.
  
  
  
  There was a significant positive correlation between ophthalmology technicians and ophthalmologist productivity (p < 0.001), number of unique patients seen per year per provider (p = 0.047), and total yearly number of office visits per provider (p < 0.001). Similarly, there was a significant positive correlation between number of ophthalmology residents and productivity (p = 0.046) and number of clinic visits per provider (p < 0.001) but not the number of unique patients seen. Positive correlation was found between optometry technicians and the number of unique patients' seen by optometrists (p = 0.041) and total number of clinic visits per provider (p < 0.001) but not optometrist productivity. No significant correlations were present for nurses, nurse practitioners, physician assistants, or clerical staff.
  
  
  
  Eye care technicians provide a cost-effective multiplier effect for provider productivity, especially in ophthalmology clinics, allowing significant increases in total clinic visits and number of unique patients seen per year.
authors.affiliation: Ophthalmology Section, VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033.
authors.forename: Mary G
authors.initials: MG
authors.lastname: Lynch
authors.affiliation: Ophthalmology Section, VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033.
authors.forename: April
authors.initials: A
authors.lastname: Maa
authors.affiliation: Center for Visual and Neurocognitive Rehabilitation, 1670 Clairmont Road, Decatur, GA 30033.
authors.forename: William
authors.initials: W
authors.lastname: Delaune
authors.affiliation: Ophthalmology Department, Emory University School of Medicine, 1365B Clifton Road, Atlanta, GA 30322.
authors.forename: Joel
authors.initials: J
authors.lastname: Chasan
authors.affiliation: Ophthalmology Section, VA Palo Alto Health Care System, 4951 Arroyo Road, Livermore, CA 94550.
authors.forename: Glenn C
authors.initials: GC
authors.lastname: Cockerham
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics / Q000592:standards*; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D005845:Georgia; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D009722:Nurse Practitioners / Q000191:economics / Q000706:statistics & numerical data; D009885:Ophthalmology / Q000592:standards*; D010823:Physician Assistants / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000458:organization & administration; D014728:Veterans / Q000706:statistics & numerical data*