{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T04:39:50Z","timestamp":1771475990403,"version":"3.50.1"},"reference-count":39,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T00:00:00Z","timestamp":1687392000000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,5,18]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aim to assess the effectiveness of a cataract surgery outcome monitoring tool used for continuous quality improvement. The objectives are to study: (1) the quality parameters, (2) the monitoring process followed and (3) the impact on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and procedures<\/jats:title>\n                    <jats:p>In this retrospective observational study we evaluated a quality improvement (QI) method which has been practiced at the focal institution since 2012: internal benchmarking of cataract surgery outcomes (CATQA). We evaluated quality parameters, procedures followed and clinical outcomes. We created tables and line charts to examine trends in key outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Aravind Eye Care System, India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Phacoemulsification surgeries performed on 718\u2009120 eyes at 10 centres (five tertiary and five secondary eye centres) from 2012 to 2020 were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>An internal benchmarking of surgery outcome parameters, to assess variations among the hospitals and compare with the best hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Intraoperative complications, unaided visual acuity (VA) at postoperative follow-up visit and residual postoperative refractive error (within \u00b10.5D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over the study period the intraoperative complication rate decreased from 1.2% to 0.6%, surgeries with uncorrected VA of 6\/12 or better increased from 80.8% to 89.8%, and surgeries with postoperative refractive error within \u00b10.5D increased from 76.3% to 87.3%. Variability in outcome measures across hospitals declined. Additionally, benchmarking was associated with improvements in facilities, protocols and processes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Internal benchmarking was found to be an effective QI method that enabled the practice of evidence-based management and allowed for harnessing the available information. Continuous improvement in clinical outcomes requires systematic and regular review of results, identifying gaps between hospitals, comparisons with the best hospital and implementing lessons learnt from peers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-071860","type":"journal-article","created":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T22:45:04Z","timestamp":1687473904000},"page":"e071860","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of practicing internal benchmarking on continuous improvement of cataract surgery outcomes: a retrospective observational study at Aravind Eye Hospitals, India"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4882-4290","authenticated-orcid":false,"given":"Ganesh-Babu Subburaman","family":"Balu","sequence":"first","affiliation":[{"name":"LAICO, Aravind Eye Care System, Madurai, India"},{"name":"Care and Public Health Research Institute (CAPHRI), Maastricht Medical Centre+, Maastricht University, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachin","family":"Gupta","sequence":"additional","affiliation":[{"name":"SC Johnson College of Business, Cornell University, Ithaca, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravindran D","family":"Ravilla","sequence":"additional","affiliation":[{"name":"Chairman, Aravind Eye Care System, Madurai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1935-7443","authenticated-orcid":false,"given":"Thulasiraj D","family":"Ravilla","sequence":"additional","affiliation":[{"name":"LAICO, Aravind Eye Care System, Madurai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Mertens","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre+, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carroll","family":"Webers","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre+, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyam","family":"Vasudeva Rao","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre+, Maastricht, The Netherlands"},{"name":"Forus Health, Bengaluru, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1918-3487","authenticated-orcid":false,"given":"Frits","family":"van Merode","sequence":"additional","affiliation":[{"name":"Care and Public Health Research Institute (CAPHRI), Maastricht Medical Centre+, Maastricht University, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"key":"2025121513452388000_13.6.e071860.1","unstructured":"World Health Organization, World Bank Group, OECD . Delivering quality health services. 2018. Available: http:\/\/apps.who.int\/bookorders"},{"key":"2025121513452388000_13.6.e071860.2","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/1468-0084.t01-2-00046","article-title":"The demand for health care services in rural Tanzania","volume":"65","author":"Sahn","year":"2003","journal-title":"Oxford Bull Econ & Stats"},{"key":"2025121513452388000_13.6.e071860.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-018-3490-2","article-title":"Demand for health care service and associated factors among patients in the community of Tsegedie district, northern Ethiopia","volume":"18","author":"Wellay","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"2025121513452388000_13.6.e071860.4","unstructured":"The strategy that will fix health care. 2021. Available: https:\/\/hbr.org\/2013\/10\/the-strategy-that-will-fix-health-care"},{"key":"2025121513452388000_13.6.e071860.5","unstructured":"Harvard TH . n.d. Using health outcomes research to improve quality of care | executive and continuing professional education. Chan School of Public Health Available: https:\/\/www.hsph.harvard.edu\/ecpe\/using-health-outcomes-research-to-improve-quality-of-care\/"},{"key":"2025121513452388000_13.6.e071860.6","doi-asserted-by":"crossref","first-page":"e144","DOI":"10.1016\/S2214-109X(20)30489-7","article-title":"Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of Avoidable blindness in relation to VISION 2020: the right to sight: an analysis for the global burden of disease study","volume":"9","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2025121513452388000_13.6.e071860.7","unstructured":"Lewallen S , Thulasiraj RD . n.d. Global public health: an international Journal for research, policy and practice eliminating Cataract blindness \u2013 how do we apply lessons from Asia to Sub- Saharan Africa."},{"key":"2025121513452388000_13.6.e071860.8","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1016\/S2214-109X(13)70003-2","article-title":"Assessment of Cataract surgical outcomes in settings where follow-up is poor: PRECOG, a Multicentre observational study","volume":"1","author":"Congdon","year":"2013","journal-title":"Lancet Glob Health"},{"key":"2025121513452388000_13.6.e071860.9","unstructured":"WHO Informal Consultation on Analysis of Blindness Prevention Outcomes (1998: Geneva, Switzerland) & WHO Programme for the Prevention of Blindness and Deafness . Informal consultation on analysis of blindness prevention outcomes, Geneva, 16-18 16-18 February 1998. World Health Organization. WHO PBL Geneva, 16-18 February 1998. n.d. Available: https:\/\/apps.who.int\/iris\/handle\/10665\/67843"},{"key":"2025121513452388000_13.6.e071860.10","unstructured":"Health AC . Healthcare systems: supporting and advancing child health. J Hosp Med 2010:91\u20132."},{"key":"2025121513452388000_13.6.e071860.11","unstructured":"Kampstra NA , Zipfel N , Van Der Nat PB , et al . Health outcomes measurement and organizational readiness support quality improvement: a systematic review. n.d. 10.1186\/s12913-018-3828-9"},{"key":"2025121513452388000_13.6.e071860.12","doi-asserted-by":"crossref","first-page":"e1460","DOI":"10.1016\/S2214-109X(21)00212-6","article-title":"Keeping an eye on eye care: monitoring progress towards effective coverage","volume":"9","author":"Keel","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2025121513452388000_13.6.e071860.13","unstructured":"Kay JFL , Qid M , Uk M , et al . Health care Benchmarking. 2007;12:22\u20137."},{"key":"2025121513452388000_13.6.e071860.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs.2010.046334"},{"key":"2025121513452388000_13.6.e071860.15","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/j.ophtha.2011.05.011","article-title":"Determination of valid benchmarks for outcome indicators in Cataract surgery: A multicenter, prospective cohort trial","volume":"118","author":"Hahn","year":"2011","journal-title":"Ophthalmology"},{"key":"2025121513452388000_13.6.e071860.16","doi-asserted-by":"publisher","DOI":"10.1038\/sj.eye.6703015"},{"key":"2025121513452388000_13.6.e071860.17","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1038\/eye.2016.240","article-title":"Benchmarks for outcome indicators in pediatric Cataract surgery","volume":"31","author":"Nihalani","year":"2017","journal-title":"Eye (Lond)"},{"key":"2025121513452388000_13.6.e071860.18","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1002\/bjs.10976","article-title":"Improving surgical outcomes through Benchmarking","volume":"106","author":"Staiger","year":"2019","journal-title":"Br J Surg"},{"key":"2025121513452388000_13.6.e071860.19","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/HMR.0b013e3181c22bdc","article-title":"Evaluation of an international Benchmarking initiative in nine eye hospitals","volume":"35","author":"de Korne","year":"2010","journal-title":"Health Care Manage Rev"},{"key":"2025121513452388000_13.6.e071860.20","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1038\/eye.2017.96","article-title":"Benchmarking cataract surgery outcomes in an ethnically diverse and diabetic population: final post-operative visual acuity and rates of post-operative cystoid macular oedema","volume":"31","author":"Oyewole","year":"2017","journal-title":"Eye"},{"key":"2025121513452388000_13.6.e071860.21","doi-asserted-by":"crossref","first-page":"E101","DOI":"10.12927\/hcpol.2012.22872","article-title":"Benchmarking: a method for continuous quality improvement in health","volume":"7","author":"Ettorchi-Tardy","year":"2012","journal-title":"Hcpol"},{"key":"2025121513452388000_13.6.e071860.22","doi-asserted-by":"publisher","DOI":"10.1097\/HMR.0b013e3182689772"},{"key":"2025121513452388000_13.6.e071860.23","doi-asserted-by":"crossref","DOI":"10.1097\/pq9.0000000000000455","article-title":"Contextual factors affecting implementation of in-hospital pediatric CPR quality improvement interventions in a resuscitation collaborative","volume":"6","author":"Dewan","year":"2021","journal-title":"Pediatric Quality & Safety"},{"key":"2025121513452388000_13.6.e071860.24","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-014121","article-title":"Revalidation and quality assurance: the application of the MUSIQ framework in independent verification visits to Healthcare organisations","volume":"7","author":"Griffin","year":"2017","journal-title":"BMJ Open"},{"key":"2025121513452388000_13.6.e071860.25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2011-000010"},{"key":"2025121513452388000_13.6.e071860.26","doi-asserted-by":"crossref","unstructured":"Lovaglio PG . The scientific Worldjournal Benchmarking strategies for measuring the quality of Healthcare. Problems and Prospects 2012;2012. doi:10.1100\/2012\/606154","DOI":"10.1100\/2012\/606154"},{"key":"2025121513452388000_13.6.e071860.27","unstructured":"Yorston D . Cataract complications. Community eye health 2008;21. Available: www.cehjournal.org"},{"key":"2025121513452388000_13.6.e071860.28","unstructured":"Gravin DA . Building a learning organization. Harv Bus Rev 1993."},{"key":"2025121513452388000_13.6.e071860.29","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/eye.2015.3","article-title":"The royal college of ophthalmologists\u2019 national ophthalmology database study of cataract surgery: report 1, visual outcomes and complications","volume":"29","author":"Day","year":"2015","journal-title":"Eye (Lond)"},{"key":"2025121513452388000_13.6.e071860.30","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1038\/sj.eye.6703015","article-title":"The cataract national dataset electronic multi-centre audit of 55,567 operations: updating benchmark standards of care in the united kingdom and internationally","volume":"23","author":"Jaycock","year":"2009","journal-title":"Eye (Lond)"},{"key":"2025121513452388000_13.6.e071860.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2012.03.006"},{"key":"2025121513452388000_13.6.e071860.32","doi-asserted-by":"publisher","DOI":"10.1108\/09544780110360624"},{"key":"2025121513452388000_13.6.e071860.33","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1108\/09596119510083238","article-title":"The role of Benchmarking in achieving continuous service quality","volume":"7","author":"Yasin","year":"1995","journal-title":"Int J Contempor Hospit Manag"},{"key":"2025121513452388000_13.6.e071860.34","first-page":"12","article-title":"Using a quality improvement process to improve Cataract outcomes","volume":"35","author":"Shivkumar","year":"2022","journal-title":"Community Eye Heal J"},{"key":"2025121513452388000_13.6.e071860.35","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.amjsurg.2015.10.008","article-title":"Reliable assessment of operative performance","volume":"211","author":"Bilgic","year":"2016","journal-title":"Am J Surg"},{"key":"2025121513452388000_13.6.e071860.36","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1016\/j.surg.2015.04.010","article-title":"The use of error analysis to assess resident performance","volume":"158","author":"D\u2019Angelo","year":"2015","journal-title":"Surgery"},{"key":"2025121513452388000_13.6.e071860.37","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1016\/j.jtcvs.2016.04.094","article-title":"Exploring the learning curve for minimally invasive Sutureless aortic valve replacement","volume":"152","author":"Murzi","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025121513452388000_13.6.e071860.38","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.ejso.2010.10.008","article-title":"Control chart methods for monitoring surgical performance: A case study from Gastro-Oesophageal surgery","volume":"37","author":"Collins","year":"2011","journal-title":"Eur J Surg Oncol"},{"key":"2025121513452388000_13.6.e071860.39","doi-asserted-by":"publisher","DOI":"10.1080\/01441640500414824"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-071860","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T21:45:30Z","timestamp":1765835130000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-071860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6,22]]},"published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1136\/bmjopen-2023-071860"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-071860","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6]]}}}