In assessing approaches to improving the care system, it is important to: (i) determine the purpose of the proposed system, for example, to screen for a threshold referral level of retinopathy or to provide guidance in management; (ii) assess the performance of the system relative to that of the gold standard, in order to identify trade-offs; (ii) assess the success and actual performance of different eye care systems in various settings; and (iv) understand how patients perceive the benefits of the system. From the perspective of health policy, it should be shown that a traditional or non-traditional proposal for care offers significant benefits over the existing system, sufficient to justify any additional costs.
The performance of systems for eye care for patients with diabetes, even in developed countres, leaves much to be desired. Application of a systems approach to the current systems indicates that alternatives should be explored to improve performance in every area of eye care for patients with diabetes in countres throughout the word.
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