A Complex Case Management System Provides Optimal Care for All Patients

Abstract

To describe the complex case management system developed by Optical Express, a large corporate provider of laser vision correction, and to detail the benefits this system offers for managing the surgical complications of laser vision correction. The classification scheme Optical Express uses to categorize surgical complications is described, and the various pathways patients can take through the complex case system are detailed. This process is illustrated with a case study describing the treatment of a patient with postoperative LASIK ectasia. The benefits of the complex case system are also discussed. A total of 1363 eyes were treated in the complex case management system during the 5-year period between January 1, 2004 and December 31, 2008. These 1363 eyes represent a small fraction (0.45%) of the approximately 300,000 eyes treated during this period. The Optical Express complex case management system organizes complications based on severity and urgency. Grade A complications (40 eyes, 2.9% of all complications) are the most serious and urgent, followed by grade B (327 eyes, 24.0%), and grade C (996 eyes, 73.1%). For each complication, the patient's journey through the complex case system starts with an evaluation by an optometrist. Depending on the severity of the complication, the patient may then be referred to the treating surgeon, a regional complex case surgeon, or an external consultant. A complex case manager coordinates care and logistics throughout this process. The complex case management system used by Optical Express provides clinical care and support for patients who experience a surgical complication.