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. 2017 Mar 1;12(3):e0172342.
doi: 10.1371/journal.pone.0172342. eCollection 2017.

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

Jacqueline Ramke  1   2 , Clare E Gilbert  3 , Arier C Lee  2 , Peter Ackland  4 , Hans Limburg  5 , Allen Foster  3
Affiliations

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

Jacqueline Ramke et al. PLoS One. .

Abstract

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 range[IQR] 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Proportion of operated eyes with presenting visual acuity of 6/18 or better (CSOGood) or worse than 6/60 (CSOPoor) plotted against observed cataract surgical coverage (CSCpersons <6/60, %) in 20 countries, 2005–2013.
WHO Targets established in 1998.[31].
Fig 2
Fig 2. Cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC; persons <6/60, %) in 20 countries, 2005–2013.
Arranged in ascending order of relative gap between CSC and eCSC (i.e. 1 –eCSC / CSC); the gap is smallest for Argentina and largest for Yemen.
Fig 3
Fig 3. Absolute inequality between women and men in cataract surgical coverage (CSCpersons <6/60), and effective cataract surgical coverage (eCSCpersons <6/60) in 20 countries, 2005–2013.
Absolute inequality is the difference between women and men (e.g. CSC in men–CSC in women); a positive value indicates women are worse off. Horizontal dashed lines and labels indicate the median values of all studies. Grey shading indicates the inter-quartile range (middle 50% of studies).
See this image and copyright information in PMC

References

    1. Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743–8. - PubMed
    1. World Health Organization. What is universal coverage? 2016. Available from: http://www.who.int/health_financing/universal_coverage_definition/en/.
    1. Donabedian A. The seven pillars of quality. Arch Pathol Lab Med. 1990;114(11):1115–8. - PubMed
    1. World Health Organization. Background paper for the technical consultation on effective coverage of health systems. Geneva: World Health Organization; 2001.
    1. Hogan D, Hosseinpoor AR, Boerma T. Developing an index for the coverage of essential health services Technical note for World health statistics 2016. Geneva: World Health Organization; 2016.