Abstract

P 302

On-line quality assurance in integrative patient care: Instruments, implementation and first experience gained within the physician network VISTANET

Angelika Händel1, Anselm Jünemann1, Pavel Pogorelov1, Hans-Ulrich Prokosch2, Alexander Beyer3, Thomas Ganslandt2, Detlef Kraska3, Serkan Beyaz3, Friedrich E. Kruse1
1Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg, Erlangen, 2Lehrstuhl für Medizinische Informatik, Universität Erlangen-Nürnberg, Erlangen, 3Medizinisches Zentrum für Informations- und Kommunikationstechnik, Universitätsklinikum Erlangen, Erlangen

Objective
VISTANET is a vertically integrated cooperation between 85 ophthalmologists and a university eye hospital. The main objective of this networking is to provide an integrative patient care based on highly quality assurance standards.
Methods
Quality assurance instruments include professional quality management systems as well as clinical pathways. The principal item is a comprehensive electronic patient record for cross-institutional data exchange. VISTANET established a web-based communication system (Siemens Soarian Integrated Care) that meets the high requirements in data security as well as being easy to handle. For data collection all pre, intra- and postoperative data sets are recorded per patient in a standardised form and carried out in real-time. Furthermore this communication system contains a tool for optical imaging. To measure patient’s satisfaction after cataract surgery VISTANET uses the Visual Function Index (VF-14) questionnaire. This questionnaire was extended by questions regarding change of visual acuity and gain of quality of life after surgical treatment.
Results
From October 2007 to January 2009 more than 10,000 data sets were recorded and evaluated. In cataract surgery mean age of patients was 74.5 ± 9 years (range 30 to 101 years). The average preoperative visual acuity was 0.375 ± 0.179 (0.001 to 0.6), the mean power of implanted lens was 21.4 ± 3.8 dpt. (-2.0 to +35.0 dpt.). The average post-operative development of the visual acuity showed a rise from 0.49 at the first post-operative control onto 0.75 at the fourth one. In a pilot study the satisfaction of 230 patients undergoing cataract surgery on both eyes was evaluated. 79.8% of the patients had significant impairment of visual acuity e.g. watching television before cataract extraction, 80.6% reported significant improvement of visual acuity after treatment.
Conclusions
The demonstrated instruments of quality assurance, particularly the implemented electronic patient record for cross-institutional data exchange are essential for integrated patient.

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