The impact of the VF-14 index, a perceived visual function measure, in the routine management of cataract patients

Background: Evidence about the impact of routine feedback of patient-reported outcomes is contradictory, and there is limited information regarding its use in the routine management of cataract patients. Methods: The VF-14 Index was used to assess the visual function of 833 consecutive cataract patients, attending 19 ophthalmologists from public and private hospitals and primary care practices in Spain, in 1999–2000. In this before/after trial, the intervention included (1) an educational session, and (2) the provision of the VF-14 scores of all subsequent patients to the ophthalmologist. Mixed effects linear and logistic models were constructed to assess the effect on the process (correlation between patients’ and physicians’ assessments of visual function, appropriateness of surgery recommendation) and the outcome of care (satisfaction). Results: The adjusted regression coefficient for the VF-14 score significantly increased after the intervention as a predictor of the ophthalmologist’s assessment of visual function (β coefficient: control 0.10 vs. intervention 0.35, p < 0.05). The intervention did not increase the probability of an appropriate medical decision (OR=0.90; 95% CI: 0.42; 2,69) and it did not change patient satisfaction with care. Conclusions: Routine provision of education and feedback on the patient’s VF-14 Index score significantly increases agreement between patients’ and physicians’ assessments of functional capacity. The lack of a beneficial effect on management or outcome suggests the need for a more intense intervention to change medical practice.