Transformation Support Provided Remotely to a National Cohort of Optometry Practices

PURPOSE: We describe the results of a practice transformation project conducted within a national cohort of optometry practices participating in the Southern New England Practice Transformation Network. METHODS: Participants were 2,997 optometrists in 1,706 practices in 50 states. The multicomponent intervention entailed curriculum dissemination through a preexisting network of optometrists supported by specialized staff and resources, and data collection through a web portal providing real-time feedback. Outcomes included practices reporting data, urgent optometry visits for target conditions, and projected cost savings achieved by reducing emergency department (ED) use through increased provision of urgent care for conditions amenable to management in optometry practices. RESULTS: Over 13 months, 69.9% of practices reported data for a mean of 6.7 months. Beginning with the fourth month, the number of urgent optometry visits increased steadily. Among reporting practices, the total cost savings were estimated at $152 million (176,703 ED visits avoided at an average cost differential of$860 per visit). Monthly projected cost savings per optometrist were substantially greater in rural vs urban practices ($10,800 vs$7,870; P \u3c .001). CONCLUSIONS: Technical assistance to promote practice transformation can be provided remotely and at scale at low per-practice cost. Through the provision of timely, easily accessed ambulatory care, optometrists can improve the patient experience and reduce ED use, thereby reducing costs. The cost savings opportunities are immense because of the large volume and high expense of ED visits for ocular conditions that might otherwise be managed in ambulatory optometry practices

Comment on: COVID-19 in Nursing Homes: Calming the Perfect Storm

To the Editor: Ouslander\u27s and Grabowski\u27s recent article which included recommendations for “Calming the Perfect Storm” of COVID‐19 in nursing facilities was timely and thorough.Although excellent in scope, in our opinion it did not address one critical area, namely, the vital role of clinical leadership to navigate this crisis. We assert that this role belongs to the nursing home medical director in an often overlooked and yet critically important partnership with the administrator, director of nursing and infection preventionist