Ep 25 Talking About Glaucoma - 29Feb2016: Nelson Winkler & Cheryl Khanna Team Based Glaucoma Care (AAC Enhanced)

/ Dartmouth-Hitchcock Medical Center/

In this episode, I talk with Nelson Winkler (a medical student at the time) and Cheryl Khanna (Glaucoma attending) at The Mayo Clinic, who analyzed the outcomes of their team based model for Glaucoma care. This physician- led model began in 2008 and has Ophthalmologists working together with Optometrists to deliver glaucoma care. With specific definitions for progression of the disease, patients are referred back to Ophthalmology at critical points or every two years if stable. This model was born out of necessity as they have just two glaucoma sub-specialists to care for a large patient population. It has allowed better allocation of resources so that patients who really need the glaucoma subspecialty care are not over-loaded with patients who are clearly stable.

They looked at the outcomes of adherence to the American Academy of Ophthalmology's Preferred Practice Patterns for glaucoma care as their metric for success of their collaborative model.

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Dr Winkler's contact information:
Winkler.Nelson@mayo.edu
Mayo Clinic
Dept. of Ophthalmology
200 First St SW
Rochester, MN 55905

Dr Khanna's contact information:
Mayo Clinic
Dept. of Ophthalmology
200 First St SW
Rochester, MN 55905
Khanna.Cheryl@mayo.edu
Phone: 
1-(507)-284-2787
1-(507)-284-2733
http://www.mayoclinic.org/biographies/khanna-cheryl-l-m-d/bio-20055437

Selected references:
1. Moroi SE, Newman-Casey PA, Dougherty Wood S, Khanna CL The Glaucoma Specialist’s Extended Care Network A patient-centered model for the future. The Glaucoma Specialist’s Extended Care Network A patient-centered model for the future. Glaucoma Today. 2015 July/August; 13(4):35-39. 
2. Ophthalmology AAO. Preferred Practice Pattern. Primary Open-Angle Glaucoma. 2010.
3. Hertzog LH, Albrecht KG, LaBree L, Lee PP. Glaucoma care and conformance with preferred practice patterns. Examination of the private, community-based ophthalmologist. Ophthalmology 1996;103(7): 1009-13.
4. Fremont AM, Lee PP, Mangione CM, Kapur K, Adams JL, Wickstrom SL, Escarce JJ. Patterns of care for open-angle glaucoma in managed care. Arch Ophthalmol 2003;121(6): 777-783.
5. Boland MV, Quigley HA, Lehmann HP. The impact of physician subspecialty training, risk calculation, and patient age on treatment recommendations in ocular hypertension. Am J Ophthalmol 2011;152(4): 638-45 e1.
6. Swamy L, Smith S, Radcliffe NM. Optic nerve complex imaging in glaucoma Medicare beneficiaries. Ophthalmic Epidemiol 2012;19(4): 249-55.
7. Albrecht KG, Lee PP. Conformance with preferred practice patterns in caring for patients with glaucoma. Ophthalmology 1994;101(10): 1668-1671.
8. Hicks NR. Some observations on attempts to measure appropriateness of care. BMJ 1994;309(6956): 730-3.
9. Murdoch I, Johnston RL. Consultant clinical decision making in a glaucoma clinic. Eye (Lond) 2010;24(6): 1028-30.
10. Vorwerk C, Thelen U, Buchholz P, Kimmich F. Treatment of glaucoma patients with insufficient intraocular pressure control: a survey of German ophthalmologists in private practice. Curr Med Res Opin 2008;24(5): 1295-301.
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Production information:

This episode was recorded live in March 2015 during the Annual Meeting of the American Glaucoma Society in Coronado, CA, using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in February 2016 on a MacBook Pro and MacPro using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue YETI Microphone and Garage Band.

Opinions expressed in this podcast  are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.
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Robert M Schertzer, MD, MEd, FRCSC
Associate Clinical Professor of Surgery
Dartmouth Medical School - Ophthalmology
Dartmouth College
podcast@iguy.org

Twitter - http://twitter.com/robschertzer
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Although I closed down the West Coast Glaucoma Center after moving to the east coast in the Fall of 2013, the website is still alive as a resource for eye information at http://westcoastglaucoma.com
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Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

 © 2016 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC