Improving preterm ophthalmologic care in the era of accountable care organizations
Authors
Wang, C JasonLittle, Alison A
Kamholz, Karen
Holliman, Jaime Bruce
Wise, Marissa D
Davis, Jonathan
Ringer, Steven
Cole, Cynthia
Vanderveen, Deborah K
Christiansen, Stephen P
Bauchner, Howard
Student Authors
Alison LittleUMass Chan Affiliations
T.H. Chan School of MedicineDocument Type
Journal ArticlePublication Date
2012-11-01
Metadata
Show full item recordAbstract
OBJECTIVES To understand retinopathy of prematurity (ROP) follow-up care for preterm very low-birth-weight infants (VLBW; <1500 g) in the context of the chronic care model and identify opportunities for improvement under accountable care organizations. METHODS We conducted focus groups and interviews with parents (N = 47) of VLBW infants and interviews with neonatal intensive care unit and ophthalmologic providers (N = 28) at 6 sites in Massachusetts and South Carolina. Themes are reported according to consolidated criteria for reporting qualitative research guidelines. RESULTS Respondents perceived that legal liability and low reimbursement contributed to shortages of ROP providers. Some neonatal intensive care units offered subsidies to attract ophthalmologic providers or delayed transfers to institutions that could not provide ROP examinations and/or treatment. Sites used variable practices for coordinating ROP care. Even at sites with a tracking database and a dedicated ROP coordinator, significant time was required to ensure that examinations and treatment occurred as scheduled. Parents' ability to manage their children's health care was limited by parental understanding of ROP, feeling overwhelmed by the infant's care, and unmet needs for resources to address social stressors. CONCLUSIONS Under accountable care organizations, hospitals and ophthalmology practices should share responsibility for ensuring coordinated ROP care to mitigate liability concerns. To promote integrated care, reimbursement for ROP care should be bundled to include screening, diagnosis, treatment, and appropriate follow-up. Clinical information systems should be enhanced to increase efficiency and limit lapses in care. Self-management tools and connections to community resources could help promote families' attendance of follow-up appointments.Source
Wang CJ, Little AA, Kamholz K, Holliman JB, Wise MD, Davis J, Ringer S, Cole C, Vanderveen DK, Christiansen SP, Bauchner H. Improving preterm ophthalmologic care in the era of accountable care organizations. Arch Ophthalmol. 2012 Nov;130(11):1433-40. doi: 10.1001/archophthalmol.2012.1890. PMID: 22777426.DOI
10.1001/archophthalmol.2012.1890Permanent Link to this Item
http://hdl.handle.net/20.500.14038/52037PubMed ID
22777426ae974a485f413a2113503eed53cd6c53
10.1001/archophthalmol.2012.1890