AN INTERPROFESSIONAL APPROACH TO UNDERSTANDING DECISION MAKING FOR TREATMENT OF CHRONIC VISUAL IMPAIRMENT: A NEW CONCEPTUAL MODEL

Purpose: Appropriate rehabilitation of patients with chronic visual impairment (VI) can both improve individual abilities for health and personal management and maximize utilization of health care resources.  There exists a need for a detailed, comprehensive understanding of health care processes and medical decision making involved in treating chronic VI.  To fill this gap, a conceptual model is presented as a foundation for understanding medical decision making by identifying an interprofessional approach to treating chronic VI.     

Methods: Components were identified from existing practice guidelines, systematic review of literature, and interprofessional feedback via focus group data.  Key concepts were synthesized into a schematic conceptual model for an interprofessional approach to treating patients with irreversible, chronic VI (a.k.a. vision rehabilitation  or VR) in the U.S. healthcare system.  A universal component of medical rehabilitation care - rehabilitation potential (ReP) of the patient - was included for patients with VI and further delineated as an important component for eye care provider decision making in VR care.  This novel conceptual model suggests factors that are significantly associated with the ReP of patients with VI by presenting important relationships of factors involved in ReP and examining the interactions of the identified variables and decision making during the VR care process. 

Results: The interprofessional approach to VR in the health care continuum leads to a proposed conceptual model integrating macro and micro level components and perspectives.  The conceptual model serves as a basis for further study and refinement in the field of VR, for understanding clinical decision making, and informs the broader field of rehabilitation medicine.

Conclusion: A novel conceptual model that integrates key concepts of clinical practice, policy and provider decision making was achieved. The model presented represents perspectives and determinants related to professionals, evidence-based clinical practice guidelines, and existing third party policy regarding chronic VI and VR care continuum.  Ongoing and subsequent research will focus on:  validating the proposed model and consensus with key stakeholders; identifying factors influencing its implementation in healthcare practice and clinical education (i.e. understanding novice and expert clinician decision making); understanding knowledge representation and underlying judgment processes in the treatment of chronic visual impairment (i.e. the roles of patient and clinician priority in making relevant decisions); and in the design of interdisciplinary clinical practice guidelines.