| A) Standard hospital model of care | B) C-EYE-C model of care | ||
|---|---|---|---|
| i) | Referral triage (hospital clinician, usually a nurse) | i) | Appointment booking (hospital administration) |
| ii) | Appointment booking (hospital administration) | ii) | Appointment booking (hospital administration) |
| iii) | Appointment check-in processing (hospital administration) | iii) | History-taking, clinical examination and imaging* and preliminary diagnosis and management decision recorded (community based optometrist) |
| iv) | History-taking, screening and imaging* (orthoptists) | iv) | Batch review of patient records to confirm or amend diagnosis and management for all patients assessed at C-EYE-C (hospital ophthalmologist) |
| v) | Clinical examination (ophthalmologist) | v) | Clerical and file processing (hospital administration) |
| vi) | Check-out and file processing (hospital administration) | vi) | Patients with clinical need are booked into a hospital glaucoma clinic |
[i] * Recommended procedures include contact tonometry, ocular coherence tomography (OCT) and automated perimetry (SITA 24-2 threshold) with a Humphries visual field analyser (VF).
Figure1
Low-risk glaucoma referrals and patient outcomes under two different models of care 2014–2017.
Table 1
Low-risk glaucoma referrals and patient outcomes under two different models of care 2014–2017.
| Standard Hospital Care | C-Eye-C | P-value | |
|---|---|---|---|
| Low-risk glaucoma referrals received | 182 | 321 | – |
| Referral dates | October 2013 to April 2016 | April 2016 to October 2017 | – |
| Mean age at referral | 64.2 years (SD ± 14.80) | 63.6 years (SD ± 13.58) | p = 0.6959^ |
| Appointment booked dates | October 2014 to April 2017 | January to November 2017 | – |
| Appointment attendance (n, %) | 125 (68.7%) | 262 (81.6%) | 0.001* |
| Median wait-time between referral and first appointment (days, IQR) | 386 (IQR: 267–428) | 89 (IQR: 53–170) | <0.001~ |
| Glaucoma diagnosis at first appointment | p < 0.001* | ||
| Glaucoma + other ocular pathology | 13 (10.4%) | 2 (0.8%) | – |
| Glaucoma only | 28 (22.4%) | 127 (48.5%) | – |
| Glaucoma Suspect | 54 (43.2%) | 109 (41.6%) | – |
| Not Glaucoma/Other | 22 (17.6%) | 18 (6.9%) | – |
| Not recorded | 8 (6.4%) | 6 (2.3%) | – |
| Recommended patient management at first appointment | P < 0.001* | ||
| Urgent hospital (<1 month) | 1 (0.8%) | 8 (3.1%) | – |
| Hospital management required (<3 months) | 31 (24.8%) | 95 (36.3%) | – |
| Routine management (>3 months) | 72 (57.6%) | 148 (56.5%) | – |
| Hospital review for another ocular condition | 1 (0.8%) | 10 (3.8%) | – |
| Discharge from service | 20 (16%) | 1 (0.4%) | – |
| Average cost per patient at first encounter | $77.00 | $133.16 | – |
[i] p-value: * Fishers Exact used for categorical data. For continuous data, ^ student’s t-test used for parametric data and ~ Mann-Whitney used for non-parametric data.
Table 2
Health systems costs per patient encounter for newly referred low-risk glaucoma patients in the standard hospital care and C-EYE-C models.
| Cost item | Hospital care | Community Eye Care (C-EYE-C) | |||
|---|---|---|---|---|---|
| Staff time per patient (mins) | Cost per patient encounter | Staff time per patient (mins) | Cost per patient encounter | ||
| C-EYE-C clinic | Hospital follow-up if required (<3mth) | ||||
| STAFFING | 83 | $129.00 | 62 | $53.58 | $116.00 |
| Administration | 13 | $21.00 | 18 | $11.11 | $21.00 |
| Nurse | 2 | $13.00 | 2 | $1.53 | $13.00 |
| Orthoptist | 43 | $10.00 | 0 | $0.00 | |
| Optometrist | 0 | – | 40 | $31.24 | |
| Ophthalmologist | 25 | $73.00 | 2 | $3.45 | $73.00 |
| On costs + exclude | $12.00 | $6.76 | $9.00 | ||
| EQUIPMENT/ | $3.00 | $4.60 | N/A | ||
| Imaging (OCT, HVF, iCARE) | $3.00 | $4.60 | N/A | ||
| INFRASTRUCTURE | $38.00 | $13.81 | $38.00 | ||
| Operating room (includes goods and services and salaries) | $6.00 | – | $6.00 | ||
| Pathology | $1.00 | – | $1.00 | ||
| Pharmacy (goods and services and pathology) | $10.00 | 3.59 | $10.00 | ||
| Prosthesis | $3.00 | – | $3.00 | ||
| Ward supplies (goods and services) | $18.00 | – | $18.00 | ||
| Rent + utilities (optometrist only) | – | $10.22 | – | ||
| Cost per patient (by clinic type) | $171.00 | $71.99 | $154.00 | ||
| AVERAGE COST PER PATIENT | $171.00 | $133.16 | |||
[i] * On costs + exclude = superannuation, worker’s compensation, long service leave and annual leave.
Table 3
Sensitivity analyses of the Community Eye Care model per patient encounter.
| Cost variable tested | Range tested | Cost per C-EYE-C patient encounter | Proportional change in cost compared to standard hospital encounter |
|---|---|---|---|
| Proportion of patients requiring hospital follow-up <3 months | 5–50% | $80.31–149.61 | –53.0% to –12.5% |
| Optometrist clinic appointments available per week (40 minute appointments) | ±50% | $129.71–143.10 | –24.1% to –16.3% |
| Optometrist consultation time | ±50% | $114.10–152.21 | –33.3% to –11.0% |
| Changes to salary (hospital administration) | ±20% | $129.28–137.03 | –24.4% to –19.9% |
| Changes to salary (all staffing) | ±20% | $113.19–153.11 | –33.8% to –10.5% |