Practical use of indicators: CSR, CSC & outcomes Susan Lewallen, MD

A place to start CSC would probably be the most important indicator to tell us how well we’re serving people Ideally we’d have a CSC of 100% in every “district” and country (assuming all surgeries had a good outcome!)

Inconvenient reality… Measuring CSC requires a population based survey –Expensive –Difficult Most “VISION 2020 Districts” will never have such a survey

CSR is more practical to measure Limitations: –requires proper record keeping to know where patient resides –requires cooperation and reporting from all providers –still not measured properly in most districts –country level CSR hides inequalities among districts –does not consider outcomes But it’s still the best we’ve got for planning and monitoring So what CSR over time would lead to a 100% CSC?

Incident cataracts Operated eyes People (eyes) who die unoperated Eyes with unop’d cataract How many surgeries required to do all the cataracts?

How can we get incidence data in developing countries? It can be modeled from age specific prevalence data obtained in population based surveys, such as RAABs Target CSR should equal annual incidence of cataract.

AFRICA Variation in target CSR needed for 100% CSC (eyes at <6/18) Hypothesis: variation due to genetic differences?

Other factors that determine what target CSR should be Population structure

LATIN AMERICA Variation in target CSR needed for 100% CSC (eyes at <6/18) Much of the variation due to age structure differences

Other factors that determine what target CSR should be VA at which cataracts are operated Better pre op VA requires higher CSR

Target CSR varies with VA

Another inconvenient reality… Not all surgeries result in sight restoration. Some bad outcomes occur

Outcomes (RAAB)

Monitoring outcomes Some hospitals/programmes do it Most do not. Why? –Extra work for someone –Culture not established –Donors not demanding it –WHO guidelines designed for use at 6 weeks But it could be done at discharge, at the hospital. Much better than nothing.

Summary- use of indicators CSC meaningful but not practical to measure Target CSR to achieve 100% CSC can be modeled from RAAB data. Useful planning tool Actual CSR can be monitored annually –Requires reasonable records –Requires cooperation among all eye care providers –Can be monitored by District or by country Outcomes -just as important as CSC –Most practical is to measure at hospital level

Thank you