Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health CoverageReport as inadecuate




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Objective

To define and demonstrate effective cataract surgical coverage eCSC, a candidate UHC indicator that combines a coverage measure cataract surgical coverage, CSC with quality post-operative visual outcome.

Methods

All Rapid Assessment of Avoidable Blindness RAAB surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome CSOGood, 6-18 or better; CSOPoor, worse than 6-60, CSC operated cataract as a proportion of operable plus operated cataract and eCSC operated cataract and a good outcome as a proportion of operable plus operated cataract were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated.

Findings

Datasets from 20 countries were included 2005–2013; 67,337 participants; 5,474 cataract surgeries. Median CSC was 53.7% inter-quartile rangeIQR 46.1–66.6%, CSOGood was 58.9% IQR 53.7–67.6% and CSOPoor was 17.7% IQR 11.3–21.1%. Coverage and quality of cataract surgery were moderately associated—every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% IQR 30.2–50.6%, approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC 4.6% IQR 0.5–7.1% than for CSC median 2.3% IQR -1.5–11.6%.

Conclusion

eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.



Author: Jacqueline Ramke , Clare E. Gilbert, Arier C. Lee, Peter Ackland, Hans Limburg, Allen Foster

Source: http://plos.srce.hr/



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