This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Timothy J. Batchelder, MD; Bruce Fireman, MA; Gary D. Friedman, MS, MD; Brian R. Matas, MD; Ira G. Wong, MD; Michael E. Barricks, MD, PhD; Steven Burke; Lindy Beasley, MBA

Arch Ophthalmol. 1997;115(9):1179-1184.

Abstract
We evaluated the cost-effectiveness of routine dilated fundus examination in improving visual outcomes. The cost of routine dilated fundus examination was related to the number of preventable cases of vision-threatening peripheral retinal disease. Patients with these diseases who had no risk factors were ascertained in a population of 1.75 million adults for a period of 6 months. Those whose last examination had been undilated were identified because only for them could routine dilated examination (RDE) have been substituted for undilated examination. The number of preventable cases was calculated for multiples of a 10% probability of prevention. The cost of RDE was determined from the number of undilated examinations in the same population and period and the cost of a single RDE. The number of patients who underwent undilated examination was estimated by random medical record review. The additional cost of a single RDE was determined from estimated examination times and payroll costs. Among patients without risk factors, 38 were identified for whom undilated examination rather than RDE had been performed. If prevention had been 10% effective, the substitution of 50 000 RDEs for undilated examinations costing the provider $433 000 would have been required per prevented case. These results suggest that most peripheral retinal diseases cannot be prevented by RDE. Routine dilated examination is an expensive test per prevented case. Published clinical guidelines lack evidence to recommend its use.

Author Affiliations
From the Departments of Ophthalmology, Kaiser Permanente Medical Center, Richmond (Dr Batchelder), San Rafael (Dr Matas), Redwood City (Dr Wong), and Oakland (Dr Barricks), Calif; the Division of Research, Kaiser Permanente Medical Care Program (Mr Fireman and Dr Friedman), and the Departments of Quality and Utilization (Mr Burke) and Operations Support Services (Ms Beasley), The Permanente Medical Group Inc, Oakland, Calif.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pharmacological mydriasis and optic disc examination
Kirwan et al.
Br J Ophthalmol 2000;84:894-898.
ABSTRACT | FULL TEXT  

Capitated Care
Van Buskirk et al.
Arch Ophthalmol 1998;116:699-701.
FULL TEXT