Differences among Ophthalmology Patients Referred to Tertiary Medical Centers according to Referral Hospital

Kim, Heesuk; Kim, Hong Kyu; Rim, Tyler Hyungtaek; Kim, Ji Won; Kim, Jin Hyung; Kim, Sung Soo

This study retrospectively reviewed 784 patients referred to the department of ophthalmology at Severance Hospital through the referral center from July 1, 2015 to June 30, 2016. An ophthalmologist reviewed the medical records of all referred patients and wrote down a final principal diagnosis for each admitted patient. A maximum of two diagnoses was allowed if a single principal diagnosis could not be determined. Patients referred for a suspected ocular disease but who were later found to not have the disease were diagnosis as "healthcare". Otherwise, based on the final diagnosis, the referred cases were classified into "cornea, retina, uveitis, glaucoma, strabismus, pediatric, neuro (ophthalmology), or oculoplasty". Cases without an ophthalmologic diagnosis were described as "others". The purpose of treatment and medical expenses were recorded to assess disease severity. Patients determined to need treatment were categorized as requiring surgical treatment, requiring hospitalization, or requiring outpatient treatment with short-interval follow-ups (within 4 to 5 days). We examined the medical expenses for ophthalmology-related outpatient treatment or hospitalization for six months after the initial hospital visit. When receiving treatment at the ophthalmology department, special doctor fees were excluded from the total expenses to rule out fee differences according to specialists. We created two types of classification systems for referral hospitals in the healthcare delivery system. First, hospitals were classified into primary-care clinics, hospitals (or general hospitals), or tertiary referral hospitals based on the number of beds. Second, hospitals were divided by functional capability in terms of doctors' medical specialty into non-eye specialists, eye specialists, and eye specialists in trainee hospital.