Barriers to efficient supply utilization in cataract surgery

白内障手术中有效利用供应的障碍

• 批准号: 10704330
• 负责人: Cassandra Thiel
• 金额: $ 41万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10704330
• 关键词: Accreditation; Administrator; Budgets; Caring; Cataract; Cataract Extraction; Consumption; Dose; Elements; Growth; Guidelines; Health Care Costs; Infection Control; Institutional Policy; Insurance Carriers; Intervention; Interview; Irrigation; Legal; Manufacturer Name; Maps; Medicare; Nurses; Operating Rooms; Operative Surgical Procedures; Ophthalmologist; Ophthalmology; Outcome; Pathway interactions; Patients; Phacoemulsification; Pharmaceutical Preparations; Pharmaceutical Solutions; Pharmacists; Pharmacologic Substance; Policies; Policy Making; Procedures; Protocols documentation; Provider; Regulation; Research; Resource-limited setting; Resources; Respondent; Risk; Safety; Societies; Sterilization; Structure; Surgeon; Surveys; Testing; Translating; Work; base; care delivery; cost; high risk; improved; interest; low income country; medical specialties; microbial; prevent; recruit; stakeholder perspectives; surgery outcome; wasting

Barriers to efficient supply utilization in cataract surgery Abstract The US spends $6.8 billion a year on cataract extraction, with the surgery consuming 12% of Medicare's budget. Unfortunately, much of this spending is wasted on unused surgical supplies and pharmaceuticals, adding to healthcare costs with no increase in value. Over 90% of surveyed cataract surgeons find operating room waste excessive. A study of pharmaceutical waste in cataract surgeries found that across four facilities, an average of 45% of drugs (by volume) were unused and discarded after every case. Two of the facilities each discarded over $190,000 worth of drugs every year, equivalent to 50 market-rate surgeries. This unnecessarily high resource use translates to higher overall costs for providers, which are in turn passed to insurers and patients. Cataract surgery and other ophthalmic procedures do not need to be so wasteful and costly. Studies of cataract surgery in lower income countries find comparable surgical outcomes with vastly different resource utilization. These “resource optimized” settings reuse surgical supplies and do not waste multi-dose drugs, reducing costs, waste, and environmental footprint while maintaining high quality outcomes, suggesting that US cataract surgery could be conducted much more efficiently. However, there are many barriers to effectively implementing these strategies. In a recent survey, US ophthalmologists cited regulatory requirements (93% of respondents) and manufacturers mandating single use of products due to liability and other motives (91%) as the primary factors preventing them from safely reusing or multi-dosing surgical supplies and drugs. Furthermore, any interventions toward resource efficiency should not sacrifice safety. Building on this body of research, our proposed study aims to systematically identify the perceived barriers to implementing more resource efficient practices in cataract surgery, from a variety of stakeholder perspectives. We will then scientifically study two specific barriers – policy and safety – to facilitate safe and effective transitions to higher-value ophthalmic care. First, we will identify perceived wasteful practices and barriers to change through interviews with surgeons, nurses, surgical technologists, administrators, and pharmacists from a variety of cataract surgical facilities (Aim 1). The national survey and anecdotal evidence suggest that regulations and accrediting bodies present a major obstacle, as well as concerns over infectious risk. Thus, we will research existing regulations and policies at federal and state levels to identify exactly which wasteful practices can be immediately modified in a safe manner and which will require alteration of existing policies (Aim 2). Finally, we will evaluate potential safety risks from supply and drug reuse by testing a variety of single use products for microbial growth after surgery (Aim 3).

白内障手术中有效利用供应的障碍 摘要 美国每年在白内障摘除上花费68亿美元，占医疗保险支出的12%。 预算不幸的是，这些支出中的大部分都浪费在了未使用的手术用品和药品上， 增加了医疗成本，但没有增加价值。超过90%的受访白内障外科医生发现 房间浪费过多。一项对白内障手术中的药物废物的研究发现，在四个设施中， 平均有45%的药物（按体积计算）在每宗个案后未经使用和丢弃。两个设施 每人每年丢弃价值超过19万美元的药物，相当于50个市场价格的手术。这 不必要的高资源使用转化为提供者的更高的总体成本，这反过来又传递给 保险公司和患者。白内障手术和其他眼科手术不需要如此浪费， 很贵。低收入国家白内障手术的研究发现， 不同的资源利用。这些“资源优化”的设置重复使用手术用品，不浪费 多剂量药物，减少成本，浪费和环境足迹，同时保持高质量的结果， 这表明美国的白内障手术可以更有效地进行。有很多 有效实施这些战略的障碍。在最近的一项调查中，美国眼科医生援引监管机构的说法， 要求（93%的受访者）和制造商因责任而要求产品一次性使用， 其他动机（91%）是阻止他们安全重复使用或多次手术的主要因素 供应品和药品。此外，任何提高资源效率的干预措施都不应牺牲安全。 在此基础上，我们提出的研究旨在系统地识别感知障碍， 从各种利益相关者的角度出发，在白内障手术中实施更具资源效率的做法。 然后，我们将科学地研究两个具体的障碍-政策和安全-以促进安全和有效的 过渡到更高价值的眼科护理。首先，我们将确定公认的浪费做法和障碍， 通过与外科医生、护士、外科技术人员、管理人员和药剂师的访谈， 各种白内障手术设施（目标1）。全国调查和传闻证据表明， 法规和认证机构以及对传染风险的担忧构成了主要障碍。因此我们 将研究联邦和州一级的现行法规和政策，以准确确定哪些浪费 可以立即以安全的方式修改实践，这将需要改变现有的政策 (Aim 2）。最后，我们将通过测试各种单一药物来评估供应和药物重复使用的潜在安全风险 手术后使用产品防止微生物生长（目标3）。