Optimization of Diabetic Macular Edema Management in the Real World: A Model of Excellence in Retina Units: The EMUREX Initiative

Abstract

Purpose: To define and develop a model of excellence for the clinical management of diabetic macular edema (DME) patients in a real-world setting. Methods: A multidisciplinary joint commission (5 ophthalmologists, 1 nurse, and 1 pharmaceutic) established a series of preliminary recommendations based on clinical guidelines and DME activity results from 8 pilot hospitals (PH). These were validated by members of each PH and a group of DME patients in discussion workshops. Thus, the validated guideline (VG) took into consideration different aspects, namely main core points (ranging 0 to 100), criteria, and indicators. Finally, each PH own-setting was compared to the VG in order to settle down a starting point to clinical excellence. Results: Mean PH score was 51.5 (range 30-65). As compared to their maximum, main points that showed better scores were Clinical Guidelines and Protocols (78%) and Portfolio of Services (73%). Topics reaching close to 50% scoring included Resources (55%), Innovation (54%), Care Process (53%), Organization (52%), and Leadership (50%). Lowest scores were observed in the Strategic Alliances (46%) and Staff (37%) points. Conclusions: Analysis of each PH by the VG delivered a global vision of the starting situation, especially focused in the identification of the different improvement areas. In order to further extend this model into the Public Health-System, the effect of implementing it in different Hospitals should be assess to analyze its impact on daily clinical practice and health economics.