LOW VISION CONSENSUS PROJECT

[Supported by grant EY 015889 from the National Eye Institute, National Institutes of Health, Bethesda MD]

The Low Vision Consensus Project is a pilot and planning project that will develop and test novel tools and methods for clinical outcome research on rehabilitation. Specifically, the project uses consensus methods to develop the details of a Bayesian decision model for low vision rehabilitation and to estimate the distributions of opinions among low vision service providers about factors that determine the outcomes of rehabilitation. This three-year project will develop and validate the instruments and methods that we will use in future outcome studies on low vision rehabilitation with the aim of optimizing the rehabilitation process. Although the current and future projects focus on low vision rehabilitation, the principles and methods developed by this research will generalize to other areas of rehabilitation. The specific aims of the Low Vision Consensus Project are:

Develop the details of a Bayesian model for decision-making and rehabilitation potential. We have developed a model that expresses rehabilitation potential as the probability that a patient with a specified set of traits, given a specified set of interventions, will have a successful outcome. The decision-making part of the model is the probability that a given decision-maker will prescribe a specified set of interventions, given a specified set of traits of the patient and given a specified decision-rule. The details of the model that must be developed include: a) itemization of a standard set of relevant patient traits and descriptions of how individual traits are specified; b) itemization of a standard set of interventions and descriptions of how individual interventions are specified; c) specifications of outcome measures; and d) specifications of variables used for decision-making and operations on those variables that represent decision-rules. This Aim will be accomplished by obtaining consensus opinions from a group of low vision rehabilitation experts using a nominal group technique.

Develop procedures and test consensus methods for measuring opinions of low vision rehabilitation service providers. Based on their personal experiences, low vision rehabilitation service providers should be able to estimate the probability of a successful outcome for a patient with a specified set of traits. Besides individual differences in experience, providers are likely to differ in their choices of interventions, in their definitions of "success," and in the decision-rules that they employ. To accomplish Aim 2, we are recruiting a sample of experienced low vision rehabilitation service providers and offering them free online courses that will earn them CE credits. To estimate the distribution of service provider opinions on probability of success, choices of interventions, definitions of "success," and specifications of decision-rules, we are employing a Delphi method where participants estimate rehabilitation potential of multiple "paper" low vision cases and respond to questionnaires on how they would manage each case.

Develop and test methods for gathering clinical data and measuring outcomes in a future collaborative study. To plan for the future collaborative clinical study, the Low Vision Rehabilitation Outcomes Project, we must develop methods of collecting data from each participating center on patient traits, interventions, costs of intervention, and measurements of outcomes. The methods must comply with HIPAA regulations and not create a data collection and documentation burden for the participating center. To accomplish Aim 3 we will employ an iterative 2-phase nominal group technique. Phase 1 will be conducted with our expert low vision rehabilitation panel to narrow the field of options and phase 2 will be conducted with the panel of low vision rehabilitation service providers to rate the feasibility of the options with respect to their own practices.

Organize a group of collaborators who will help plan and execute a future clinical study. The goal of the Low Vision Consensus Project is to prepare for and plan the multi-center collaborative Low Vision Rehabilitation Outcomes Project (LVROP). The LVROP will a) compare service provider estimates of probabilities and decision-making variables to empirically measured values, b) measure changes in service provider estimates in response to feedback of measured values from their own centers, and c) measure changes in service provider behavior, estimates, and center outcomes in response to feedback of data from other centers. The objective of the LVROP is to develop and validate methods that could be used to implement an evidence-based, self-optimizing system of low vision rehabilitation. To accomplish Aim 4, we will recruit collaborators from our panel of low vision rehabilitation service providers who will participate in consensus studies for Aims 2 and 3. Other collaborators will include members of our panels of consultants.

If you are a low vision rehabilitation service provider and you are interested in participating in the Low Vision Consensus Project in exchange for free CE, register for the Low Vision Rehabilitation Network [link to registration page] and click on 'Enroll in Low Vision Rehabilitation Consensus Project' after you log in.