Byers Eye Horngren Family Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California

Transcription

1 The Importance of Keeping a Broad Differen6al In Re6na Clinic: The Spectrum of Disease Seen By Re6nal Specialists in a Ter6ary Outpa6ent Clinic Se@ng Darius M. Moshfeghi 1, MD, Suzann Pershing, MD 1, Natalia Fijalkowski 1 1 Byers Eye Ins@tute, Horngren Family Vitreore@nal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California PURPOSE: To answer: Who and what do re,nal specialists in the United States see in clinic?. Table 2. Top 10 Most Common Primary Diagnoses for Pa@ents Referred to Re@nal Specialists METHODS: RESULTS : Retrospec@ve chart review of all new pa@ents referred to a re@n specialist at the Horngren Vitreore@nal Center at Byers Eye Ins@tute from January 1, 2008 to December 31, The pa@ents electronic medical records were examined for the following characteris@cs: 1) Date of service 2) Provider 3) All ICD- 9 ophthalmic diagnoses associated with the ini@al visit 4) Pa@ent age 5) Gender. Similar diagnoses were grouped together into broad diagnosis categories for analysis purposes. For example, Re@nopathy of Prematurity (ROP) category included premature screening, all stages of ROP and retrolental fibroplasia. Sta@s@cal analysis was performed using SAS 4.3. Sta@s@cal significance was set as a p- value of < Measures of central tendency were used to describe the data and appropriate sta@s@cal tests were used to compare groups. Table 1. Baseline Characteris@cs of New Pa@ents in Re@na Clinic - Overall there was an equal gender distribu@on among new re@nal pa@ents (p=0.18) - The age distribu@ons did not change year- to- year (p=0.48) - Pa@ents over the age of 51 years old made up 61.8% of all visits - The next most common diagnoses were myopia and migrane - The number of secondary diagnoses did not change over the course of the study (P=0.38) * There was a sta@s@cally significant difference between the gender distribu@on - The age distribu@on of new pa@ents seen by ophthalmologists exhibits a bimodal distribu@on with peaks at early childhood and later decades of life. - Youngest age group had a significantly higher number of male pa@ents (p<0.001) - Higher propor@on of females in two of the eldest age groups (p<0.01 for years and p<0.001 for 81+ years). CONCLUSIONS: Re@nal specialists treat pa@ents across the age spectrum The most common diagnoses differed by age group Diabetes is a leading cause of referral at every age group and is the primary diagnosis for pa@ents ages 11 to 70 years of age. Males are overrepresented in the youngest age groups while females are overrepresented in the elderly age groups New pa@ents have a vast spectrum of disease The familiar VINDICATE mnemonic, describing broad diagnosis categories, reminds all ophthalmologists of the miscellany of condi@ons that can have ocular manifesta@ons. This study provides important demographic and epidemiological profiles so that ter@ary ophthalmic centers can allocate resources appropriately to best address the needs of this pa@ent popula@on Table 3. The most common diagnoses in re@na clinic by disease category

2 The Importance of Keeping a Broad Differen6al In Re6na Clinic: The Spectrum of Ophthalmic Disease Seen By Re6nal Specialists PURPOSE: To answer: Who and what do re,nal specialists in the United States see in clinic?. METHODS: Retrospec@ve chart review of all new pa@ents referred to a re@na specialist at the Horngren Vitreore@nal Center at Byers Eye Ins@tute from January 1, 2008 to December 31, The pa@ents electronic medical records were examined for the following characteris@cs: 1) Date of service 2) Provider 3) All ICD- 9 ophthalmic diagnoses associated with the ini@al visit 4) Pa@ent age 5) Gender. Similar diagnoses were grouped together into broad diagnosis categories for analysis purposes. For example, Re@nopathy of Prematurity (ROP) category included premature screening, all stages of ROP and retrolental fibroplasia. Sta@s@cal analysis was performed using SAS 4.3. Sta@s@cal significance was set as a p- value of < Measures of central tendency were used to describe the data and appropriate sta@s@cal tests were used to compare groups.

3 RESULTS Table 1. Baseline Characteris6cs of New Pa6ents Seen By Re6nal Specialists Over a Four- Year Period at a Ter6ary Academic Outpa6ent Ophthalmology Center There were five re@nal specialists in 2008, six in 2009 and seven for years 2010 and 2011 billing for new pa@ents. The distribu@on was not evenly distributed therefore median and range values are presented. 7,197 new pa@ents 7,093 had complete ICD- 9 data (98.6%) No change in age distribu@on year- by- year(p=0.48) Overall, there was no difference between propor@on of female and male pa@ents (p=0.18) in the study. 61.8% of all new re@na clinic pa@ents were over 51 years old.

4 RESULTS *There was a sta@s@cally significant difference between the gender distribu@on The age distribu@on of new pa@ents seen by ophthalmologists exhibits a bimodal distribu@on with peaks at early childhood and later decades of life. Youngest age group had a significantly higher number of male pa@ents (p<0.001) Higher propor@on of females in two of the eldest age groups (p<0.01 for years and p<0.001 for 81+ years).

5 RESULTS Table 2. Top 10 Most Common Primary Diagnoses for Pa6ents Referred to Re6nal Specialists Eye Disease leading cause of specialist referral (most commonly Type 2 Diabe@c Re@nopathy) The ten most common broad diagnoses categories only accounted for 69.1% of all diagnosis codes The next most common diagnoses were myopia and migrane The number of secondary diagnoses did not change over the course of the study

6 CONCLUSIONS Table 3. Keeping the Differen6al Broad: The Three Most Common Diagnoses by Re6nal Specialists In Each Disease Category specialists treat across the age spectrum The most common diagnoses differed by age group Diabetes is a leading cause of referral at every age group and is the primary diagnosis for pa@ents ages 11 to 70 years of age. Males are overrepresented in the youngest age groups while females are overrepresented in the elderly age groups New pa@ents have a vast spectrum of disease The familiar VINDICATE mnemonic, describing broad diagnosis categories, reminds all ophthalmologists of the miscellany of condi@ons that can have ocular manifesta@ons. This study provides important demographic and epidemiological profiles so that ter@ary ophthalmic centers can allocate resources appropriately to best address the needs of this pa@ent popula@on