BOOST (Better Operative BOOST (Better Operative Outcomes Software Tool)Outcomes Software Tool)

Nathan CongdonNathan Congdon

Queen’s University Belfast

Zhongshan Ophthalmic Center, Guangzhou, China

ORBIS International, NY, USA

Why is it important to measure Why is it important to measure cataract surgical quality?cataract surgical quality?

• Quality of surgery and Quality of surgery and resulting patient resulting patient satisfaction are the satisfaction are the engines that drive a engines that drive a sustainable cataract sustainable cataract serviceservice

• We must be able to We must be able to measure quality before measure quality before we can create itwe can create it

Why don’t we routinely measure Why don’t we routinely measure cataract surgical outcomescataract surgical outcomes??

• Busy cliniciansBusy clinicians• Lack of resources and Lack of resources and

awareness about awareness about existing free optionsexisting free options

• Some available systems Some available systems to record cataract to record cataract outcomes offer very outcomes offer very powerful functionality, powerful functionality, but may be challenging but may be challenging for new users (“The for new users (“The SLR camera”)SLR camera”)

• Poor patient follow-up: Poor patient follow-up: How do we make sense How do we make sense of data with a range of of data with a range of different follow-up different follow-up times?times?

PRECOG project: Assessing cataract PRECOG project: Assessing cataract outcomes where follow-up is pooroutcomes where follow-up is poor

• 40 hospitals in 12 40 hospitals in 12 countries (Asia, countries (Asia, Africa, LAC)Africa, LAC)

• 4000 surgical cases, 4000 surgical cases, final outcomes final outcomes recorded for > 90%recorded for > 90%

Assessing cataract outcomes where Assessing cataract outcomes where follow-up is poorfollow-up is poor

• Validated two Validated two approaches to approaches to measuring quality measuring quality when few patients when few patients return:return:– Early assessment for Early assessment for

ALL patients (First ALL patients (First Day)Day)

– Late (> 6 weeks) Late (> 6 weeks) assessment of all assessment of all those who DO return those who DO return (even when rates <= (even when rates <= 30%)30%)

rho = 0.74, P < 0.001rho = 0.74, P < 0.001

Early All

Lat

e A

ll

rho = 0.86, P < 0.001rho = 0.86, P < 0.001

Lat

e A

ll

Late Return

Existing software solutionsExisting software solutions

• Some high-quality Some high-quality software systems exist software systems exist to measure cataract to measure cataract surgical outcomessurgical outcomes

– Monitoring software Monitoring software from ICEH, developed from ICEH, developed by Hans Limburgby Hans Limburg

– Aravind’s surgery Aravind’s surgery outcome monitoring outcome monitoring softwaresoftware

What is BOOST?What is BOOST?

• Unite behind a single Unite behind a single cataract outcomes cataract outcomes monitoring systemmonitoring system– Aravind, ICEH, NGOs, Aravind, ICEH, NGOs,

IAPB, ICO, WHO, end-IAPB, ICO, WHO, end-users, etc.users, etc.

• Exploit the fact that Exploit the fact that earlier assessment of earlier assessment of outcomes now outcomes now practical due to practical due to widespread use of widespread use of small incisions (SICS, small incisions (SICS, phaco)phaco)

What is BOOST?What is BOOST?

• Simple default Simple default settings:settings:– A “point and A “point and

shoot” instead of shoot” instead of an SLRan SLR

• Capacity for more Capacity for more powerful, flexible powerful, flexible functionality as functionality as neededneeded

• Quick to download, Quick to download, can be used offlinecan be used offline

Vision Vision 20202020

Vision Vision 20202020

What is BOOST?What is BOOST?

• Following protocol Following protocol validated in PRECOG, validated in PRECOG, system will system will automatically step the automatically step the user through collection user through collection of the minimum data set of the minimum data set needed to:needed to:

– Assess existing outcome Assess existing outcome quality (60 consecutive quality (60 consecutive cases, post-op day #1)cases, post-op day #1)

What is BOOST?What is BOOST?

• Identify and suggest Identify and suggest measures to correct measures to correct principal cause of poor principal cause of poor outcomes (20 cases outcomes (20 cases with VA < 6/60 at 6 with VA < 6/60 at 6 weeks)weeks)

– Surgical complicationsSurgical complications– Inappropriate case Inappropriate case

selection (co-selection (co-morbidities)morbidities)

– Refractive Refractive error/inaccurate IOL error/inaccurate IOL powerpower

What is BOOST?What is BOOST?• The system will be based on a The system will be based on a

stable platform for long-term stable platform for long-term useuse– AravindAravind

• NGOs, IAPB, WHO, partners NGOs, IAPB, WHO, partners institutions, etc., will join institutions, etc., will join together to:together to:– Support Support developmentdevelopment of the of the

systemsystem– Support Support long-termlong-term maintenancemaintenance– Advertise and promoteAdvertise and promote

universal, free access by universal, free access by download from websites download from websites everywhere: the “Angry Birds” everywhere: the “Angry Birds” of eye health!of eye health!

What is BOOST?What is BOOST?• Cloud-based databaseCloud-based database

• Password-protected Password-protected user accounts, user user accounts, user decides who sees decides who sees their datatheir data

• Will exist as a de Will exist as a de novo, cross-platform novo, cross-platform app, strong input on app, strong input on design from ICEH and design from ICEH and AravindAravind

Progress to DateProgress to Date

• Marketing survey at 90 hospitals in Marketing survey at 90 hospitals in Africa, Asia, LAC, Pacific:Africa, Asia, LAC, Pacific:

– Strong support (90%) for sharing data Strong support (90%) for sharing data anonymously in cloudanonymously in cloud

– Strong demand for continuous (not one Strong demand for continuous (not one off) use, and for functionality both to off) use, and for functionality both to measuremeasure and and improveimprove quality quality

Progress to DateProgress to Date

• Completion of Windows version at Completion of Windows version at AravindAravind

• Identification of programmers and Identification of programmers and funding sought to migrate to Android funding sought to migrate to Android platformplatform

• Preparation for formal field testing:Preparation for formal field testing:– Original PRECOG Cohort and market survey Original PRECOG Cohort and market survey

institutionsinstitutions– Letter in Lancet Global Health seeking Letter in Lancet Global Health seeking

additional testing institutionsadditional testing institutions

Improving Cataract Improving Cataract Surgical QualitySurgical Quality

• The road to improving The road to improving cataract surgical quality cataract surgical quality is a long oneis a long one

– Many institutions have Many institutions have not even started the not even started the journey due to lack of a journey due to lack of a carcar

– We propose to provide a We propose to provide a robust, simple, high-robust, simple, high-quality bicyclequality bicycle

Thank YouThank You

Vision 2020Vision 2020