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Parham MJ, Williams AD, Layon SA, Burns HR, Abu-Ghname A, Hollier LH. Geospatial Demand for Approved Cleft Care in the United States. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6090. [PMID: 39188962 PMCID: PMC11346850 DOI: 10.1097/gox.0000000000006090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/26/2024] [Indexed: 08/28/2024]
Abstract
Background Geographic information systems are powerful tools for characterizing the geospatial factors influencing access to care. As patients with cleft lip and/or palate (CL/P) require long-term care, with numerous operations and therapies, access to timely, quality care is extremely important. This study uses population level analysis and geographic information systems to identify United States counties with limited access to American Cleft Palate Association-approved cleft teams. Methods Natality data were queried from the National Vital Statistics System. Population and geographic data were obtained from the US Census Bureau. The Social Vulnerability Index (SVI) was utilized to account for social inequality. Total births with CL/P, population estimates, SVI, distance to the nearest center, and total centers within 50 km were used to generate the cleft care demand index (CCDI). Results Ninety-two counties had CCDIs between 66.7 and 100. The highest scoring county, Hidalgo County, Texas, had 62 births with CL/P, population estimate of 888,367 persons, distance to the nearest cleft center of 368.4 km, and SVI of 0.99. Conclusions This study demonstrates the power of geographic information systems for identifying areas with limited access to approved cleft teams. The CCDI measures cleft burden, socioeconomic disadvantage, and geographic barriers to quantify the demand for approved cleft care in each county. Utilizing these scores can help direct future interventions, outreach efforts, and cleft care center planning.
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Affiliation(s)
- Matthew J. Parham
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.; and Division of Plastic Surgery, Texas Children’s Hospital, Houston, Tex
| | - Austin D. Williams
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.; and Division of Plastic Surgery, Texas Children’s Hospital, Houston, Tex
| | - Sarah A. Layon
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.; and Division of Plastic Surgery, Texas Children’s Hospital, Houston, Tex
| | - Heather R. Burns
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.; and Division of Plastic Surgery, Texas Children’s Hospital, Houston, Tex
| | - Amjed Abu-Ghname
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.; and Division of Plastic Surgery, Texas Children’s Hospital, Houston, Tex
| | - Larry H. Hollier
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.; and Division of Plastic Surgery, Texas Children’s Hospital, Houston, Tex
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Chen KW, Jiang A, Kapoor C, Fine JR, Brandt JD, Chen J. Geographic Information System Mapping of Social Risk Factors and Patient Outcomes of Pediatric Glaucoma. Ophthalmol Glaucoma 2022; 6:300-307. [PMID: 36427749 DOI: 10.1016/j.ogla.2022.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to use Geographic Information System (GIS) mapping to present the geospatial distribution of visual outcomes and sociodemographic risk factors of a cohort of pediatric glaucoma patients. DESIGN Retrospective cohort study. SUBJECTS 233 eyes of 177 pediatric glaucoma patients treated at UC Davis Medical Center. METHODS We reviewed the medical records of pediatric patients (aged less than 18 years) with the diagnosis of pediatric glaucoma or any adult with a prior history of pediatric glaucoma at UC Davis Medical Center from 2001 to 2019. Patient sociodemographic information and ocular health data were recorded. Patients were mapped to their residential home 3-digit zip code prefix using ArcGIS software to generate geographic representations of the pediatric glaucoma database. Statistical analyses were performed to identify significant risk factors to poor visual outcome. MAIN OUTCOME MEASURES The primary outcome was the patient's final visual acuity (VA), defined as a binary variable based on the World Health Organization's criteria: good VA (better than 20/200) or poor VA (worse than 20/200). The secondary outcome was final intraocular pressure (IOP) at patients' final follow-ups. Risk factors for poor vision and higher IOP were assessed. RESULTS At final follow-up, 65 eyes (27.9%) had poor vision and 168 eyes (72.1%) had good vision. In the multivariate analysis, the odds ratio of good VA decreased by 4% for every 1 mmHg increase in initial IOP (P = 0.03), and the odds of good VA decreased by 6% for every year increase in age (P = 0.04). Patients with private insurance had a 3.5 mmHg lower final IOP than those with Medicaid (P = 0.004). Travel distance was not associated with a poorer visual outcome. CONCLUSIONS Private insurance patients had lower final IOP than Medicaid patients. Age and initial IOP were significant negative predictors of VA. Despite travel distance appearing to be associated with poorer visual outcomes by GIS mapping, it was not statistically significant. Geographic information system mapping of patient outcomes is an innovative way to visualize patient demographics and risk factors. Geographic information system may prove particularly useful in larger nationwide disease and surgical registries, especially for rare disorders like pediatric glaucoma. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Kevin W Chen
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Angela Jiang
- University of California, Davis Eye Center, Sacramento, California
| | - Chandni Kapoor
- University of California, Davis School of Medicine, Sacramento, California
| | - Jeffrey R Fine
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, California
| | - James D Brandt
- University of California, Davis Eye Center, Sacramento, California
| | - Jenny Chen
- University of California, Davis Eye Center, Sacramento, California.
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Chung M, Robinson B, Fukuda M, Dunbar JA, Ulangca RA, Khazaeni LM. Access to Pediatric Eye Care Following Vision Screening. J Pediatr Ophthalmol Strabismus 2022; 59:369-374. [PMID: 35275779 DOI: 10.3928/01913913-20220210-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To quantify the accessibility of eye care providers from photoscreening centers within the vision screening region in relation to population density and median household income. METHODS Driving times between vision screening locations and eye care centers were mapped and analyzed using OpenStreetMap software (Open Street Map Foundation). U.S. Census Bureau data of population density and median household income were linked with screening centers using ArcGIS Online (Esri) to determine correlations with driving times. RESULTS A total of 290 driving times for 145 photo-screening centers, 147 optometrists, and 7 pediatric ophthalmologists were calculated and mapped. Median driving times from a photoscreening center to the nearest optometrist and ophthalmologist were 4.74 and 25.10 minutes, respectively, with 90% of the screening centers residing within 12.46 and 67.19 minutes of the nearest optometrist and ophthalmologist, respectively. Driving times to optometrists are far less than times to pediatric ophthalmologists due to the greater number of optometrists. Decreasing driving times with increasing population and median household income indicate the concentration of optometrists and pediatric ophthalmologists within urbanized areas. CONCLUSIONS Most photoscreening centers reside within 5 and 70 minutes of the nearest optometrist and pediatric ophthalmologist, respectively. Driving times indicate the region's greater accessibility to optometrists than to pediatric ophthalmologists. Eye care centers tend to be localized within urbanized areas with higher population densities and higher median household incomes. [J Pediatr Ophthalmol Strabismus. 2022;59(6):369-374.].
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Yim D, Chandra S, Sondh R, Thottarath S, Sivaprasad S. Barriers in establishing systematic diabetic retinopathy screening through telemedicine in low- and middle-income countries. Indian J Ophthalmol 2021; 69:2987-2992. [PMID: 34708733 PMCID: PMC8725078 DOI: 10.4103/ijo.ijo_1411_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vision-threatening diabetic retinopathy (VTDR) is one of the leading causes of impaired vision in the working-age population. Early identification, timely diagnosis, and prompt treatment of VTDR have to be tackled simultaneously to reduce the rate of blindness due to this condition. Considerable emphasis has been placed globally on establishing diabetic retinopathy screening (DRS) programs to enable early identification and referral of VTDR for treatment. However, there is an urgent need to shift from the common practice of opportunistic screening to a systematic DRS pathway to ensure that individuals with diabetes are screened at regular intervals and treated appropriately. While systematic DRS programs have been successfully established in countries such as the United Kingdom (UK), it continues to be a challenge to initiate and sustain such programs in low- and middle-income countries (LMIC), home to approximately 80% of people with diabetes. Telemedicine is widely recognized as an ideal DRS screening program. Although it has resulted in an upsurge of opportunistic screening, systematic recall of screened patients remains a challenge. In addition, the link between referred patients from the telemedicine programs to treatment centers is often not established or has failed to deliver; so, there is minimal impact of these telemedicine programs on VTDR blindness at present. This review covers the various barriers of establishing and sustaining systematic telemedicine DRS programs, especially in resource-constrained settings, and the challenges in aligning telemedicine to VTDR treatment pathways to ensure patients with VTDR are treated promptly and effectively.
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Affiliation(s)
- Daniel Yim
- St. George's Medical School, University of London, London, UK
| | - Shruti Chandra
- University College London, Institute of Ophthalmology; NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Rajan Sondh
- St. George's Medical School, University of London, London, UK
| | - Sridevi Thottarath
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Sobha Sivaprasad
- University College London, Institute of Ophthalmology; NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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Zhong J, Wang W, Wang H, Huang J, Li T, Chen J, Chen W, Yuan J, Chen W. Distribution and determinants of hospital efficiency and relative productivity in county-level hospitals in rural China: an observational study. BMJ Open 2021; 11:e042326. [PMID: 34215595 PMCID: PMC8256740 DOI: 10.1136/bmjopen-2020-042326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical distribution of cataract surgeons and prospectively identify the factors associated with the increased productivity in cataract surgery and efficiency in outpatient ophthalmic services in rural Chinese hospitals. METHODS Data were prospectively collated from various hospital datasets and the census registered by the geographical unit county. Prior to mapping, the geographical location data of counties were cross-linked with the equivalent ophthalmologist and service output data to create categories and map multiple data attributes. Descriptive statistical analyses were performed to characterise the data stratified by county. Linear regression analyses were used to explore the factors associated with the increased productivity/efficiency. RESULTS The ophthalmologists, surgical productivity of ophthalmologists and outpatient efficacy of ophthalmologists significantly varied across counties. During the period between 2016 and 2018, the median (IQR) change in surgical productivity of and outpatient efficacy of ophthalmologists were 31.627 (-3.33 to 29.94) and 118.08 (-132.30 to 740.89). In the simple regression analysis for predictors of a high productivity change, only the increased number of phaco machine had statistical significance (p=0.003). In addition, only the gross domestic product per capita in 2016 was associated with an increased improvement in efficiency of outpatient services (p=0.008). CONCLUSIONS This study demonstrated that the ophthalmologist productivity and the efficiency of outpatient services were unequally geographically distributed, and their predictors were identified. Further studies to elucidate the extent of the problem and improve the health service delivery models are required.
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Affiliation(s)
- Jing Zhong
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Wei Wang
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Hongxi Wang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jingjing Huang
- Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tao Li
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jingjing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jin Yuan
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Weirong Chen
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Clemens KK, Ouédraogo AM, Garg AX, Silver SA, Nash DM. Opportunities To Improve Diabetes Care in the Hemodialysis Unit: A Cohort Study in Ontario, Canada. KIDNEY360 2021; 2:653-665. [PMID: 35373046 PMCID: PMC8791316 DOI: 10.34067/kid.0007082020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/09/2021] [Indexed: 02/04/2023]
Abstract
Background Patients with diabetes receiving chronic, in-center hemodialysis face healthcare challenges. We examined the prevalence of gaps in their diabetes care, explored regional differences, and determined predictors of care gaps. Methods We conducted a population-based, retrospective study between January 1, 2016 and January 1, 2018 in Ontario, Canada. We included adults with prevalent diabetes mellitus receiving in-center hemodialysis as of January 1, 2018 and examined the proportion with (1) insufficient or excessive glycemic monitoring, (2) suboptimal screening for diabetes-related complications (retinopathy and cardiovascular screening), (3) hospital encounters for hypo- or hyperglycemia, and (4) hospital encounters for hypertension in the 2 years prior (January 1, 2016 to January 1, 2018). We then identified patient, provider, and health-system factors associated with more than one care gap and used multivariable logistic regression to determine predictors. Further, we used geographic information systems to explore spatial variation in gaps. Results There were 4173 patients with diabetes receiving in-center hemodialysis; the mean age was 67 years, 39% were women, and the majority were of lower socioeconomic status. Approximately 42% of patients had more than one diabetes care gap, the most common being suboptimal retinopathy screening (53%). Significant predictors of more than one gap included younger age, female sex, shorter duration of diabetes, dementia, fewer specialist visits, and not seeing a physician for diabetes. There was evidence of spatial variation in care gaps across our region. Conclusions There are opportunities to improve diabetes care in patients receiving in-center hemodialysis, particularly screening for retinopathy. Focused efforts to bring diabetes support to high-risk individuals might improve their care and outcomes.
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Affiliation(s)
- Kristin K. Clemens
- Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, Ontario, Canada
- Center for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | | | - Amit X. Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Samuel A. Silver
- ICES, Ontario, Canada
- Division of Nephrology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Danielle M. Nash
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, Ontario, Canada
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Brady CJ, D'Amico S, Withers N, Kim BY. Using Public Datasets to Identify Priority Areas for Ocular Telehealth. Telemed J E Health 2021; 27:1293-1298. [PMID: 33600257 DOI: 10.1089/tmj.2020.0433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose: Telemedicine can expand access to ocular services, but barriers include restrictive policies and poor reimbursement. A tool to identify priority regions for interventions is needed. Methods: Eye care provider (ECP) density, self-reported visual disability, and demographics were calculated using census data and professional registries. The relationship between visual disability and ECP density was explored in fractional regression models. These data were compared with state telemedicine policy favorability. Results: For each additional ECP per 100,000 population, there was 0.0111% less disability in the county (95% confidence interval -0.0150% to -0.00719%) in an adjusted model. Of 3,142 counties, 1,078 (34%) were in the worst population-weighted quartile for ECP density and visual disability. Conclusions: Low ECP density is associated with higher visual disability, suggesting an opportunity for ocular telehealth. Counties with favorable policy climates should be prioritized for telemedicine implementation. Public datasets can be used to survey wide geographic areas to identify areas worthy of detailed needs assessments.
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Affiliation(s)
- Christopher J Brady
- Division of Ophthalmology, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.,Division of Ophthalmology, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA.,Vermont Center on Behavior and Health, Larner College of Medicine, Burlington, Vermont, USA
| | - Samantha D'Amico
- Division of Ophthalmology, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Natasha Withers
- Ambulatory Care, Porter Medical Center, University of Vermont Health Network, Middlebury, Vermont, USA
| | - Brian Y Kim
- Division of Ophthalmology, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.,Division of Ophthalmology, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
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Lanzetta P, Sarao V, Scanlon PH, Barratt J, Porta M, Bandello F, Loewenstein A. Fundamental principles of an effective diabetic retinopathy screening program. Acta Diabetol 2020; 57:785-798. [PMID: 32222818 PMCID: PMC7311555 DOI: 10.1007/s00592-020-01506-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults worldwide. Early detection and treatment are necessary to forestall vision loss from DR. METHODS A working group of ophthalmic and diabetes experts was established to develop a consensus on the key principles of an effective DR screening program. Recommendations are based on analysis of a structured literature review. RESULTS The recommendations for implementing an effective DR screening program are: (1) Examination methods must be suitable for the screening region, and DR classification/grading systems must be systematic and uniformly applied. Two-field retinal imaging is sufficient for DR screening and is preferable to seven-field imaging, and referable DR should be well defined and reliably identifiable by qualified screening staff; (2) in many countries/regions, screening can and should take place outside the ophthalmology clinic; (3) screening staff should be accredited and show evidence of ongoing training; (4) screening programs should adhere to relevant national quality assurance standards; (5) studies that use uniform definitions of risk to determine optimum risk-based screening intervals are required; (6) technology infrastructure should be in place to ensure that high-quality images can be stored securely to protect patient information; (7) although screening for diabetic macular edema (DME) in conjunction with DR evaluations may have merit, there is currently insufficient evidence to support implementation of programs solely for DME screening. CONCLUSION Use of these recommendations may yield more effective DR screening programs that reduce the risk of vision loss worldwide.
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Affiliation(s)
- Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy.
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy.
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| | - Peter H Scanlon
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jane Barratt
- International Federation on Ageing, Toronto, Canada
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Anat Loewenstein
- Department of Ophthalmology Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yan F, Guo J, Mayberry R, Luo Q, Li Y, Qin G. Diabetes retinopathy and related health management in Asians versus whites using BRFSS 2005-2017 data. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2019; 11:310-317. [PMID: 31993107 PMCID: PMC6971498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Asian Americans had high rate of type 2 diabetes and less risk for diabetes complications compared to white. The purpose of this study was to examine diabetic retinopathy and related healthcare management among Asian American adults with diabetes. MATERIALS AND METHOD Asian and white type 2 diabetes participants from 2005-2017 Behavioral Risk Factor Surveillance System (BRFSS) data were used to perform the analysis. SAS 9.4 survey procedures were used to conduct the statistical test. Health care management variables (self-blood sugar check, eye check and HbA1C check with doctors, health care professional visit) were analyzed and compared between Asian and white. RESULTS During 2005-2017, diabetic retinopathy (DR) rate among Asian Americans was 10% higher than white, and Asian Americans was more than 100% more likely to develop DR compared to white. Asian Americans was less likely to check their blood sugar once a day (P<0.05 for all years except 2005 and 2007) and more likely to see the health care professional and perform eye and HbA1C check even the relationship was not statistically significant. After adjusting all the demo-social factors and health care management factors, Asian still had higher rate of DR compared to white. CONCLUSION Asian Americans had higher rate of DR rate compared to white. Asian and white all had low rate of selfcare of blood sugar. Interventions for DR need to apply among Asian population.
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Affiliation(s)
- Fengxia Yan
- Community Health and Preventive Medicine, Morehouse School of MedicineAtlanta, GA, USA
| | - Jianfei Guo
- Liaocheng District HospitalShangdong Province, China
| | - Robert Mayberry
- Community Health and Preventive Medicine, Morehouse School of MedicineAtlanta, GA, USA
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Benoit SR, Swenor B, Geiss LS, Gregg EW, Saaddine JB. Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010-2014. Diabetes Care 2019; 42:427-433. [PMID: 30679304 DOI: 10.2337/dc18-0828] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 11/24/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults, and although screening with eye exams is effective, screening rates are low. We evaluated eye exam visits over a 5-year period in a large population of insured patients 10-64 years of age with diabetes. RESEARCH DESIGN AND METHODS We used claims data from IBM Watson Health to identify patients with diabetes and continuous insurance coverage from 2010 to 2014. Diabetes and DR were defined using ICD-9 Clinical Modification codes. We calculated eye exam visit frequency by diabetes type over a 5-year period and estimated period prevalence and cumulative incidence of DR among those receiving an eye exam. RESULTS Among the 298,383 insured patients with type 2 diabetes and no diagnosed DR, almost half had no eye exam visits over the 5-year period and only 15.3% met the American Diabetes Association (ADA) recommendations for annual or biennial eye exams. For the 2,949 patients with type 1 diabetes, one-third had no eye exam visits and 26.3% met ADA recommendations. The 5-year period prevalence and cumulative incidence of DR were 24.4% and 15.8%, respectively, for patients with type 2 diabetes and 54.0% and 33.4% for patients with type 1 diabetes. CONCLUSIONS The frequency of eye exams was alarmingly low, adding to the abundant literature that systemic changes in health care may be needed to detect and prevent vision-threatening eye disease among people with diabetes.
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Affiliation(s)
- Stephen R Benoit
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bonnielin Swenor
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - Linda S Geiss
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jinan B Saaddine
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Gao X, Park CH, Dedrick K, Borkar DS, Obeid A, Reber S, Federman J. Use of Telehealth Screening to Detect Diabetic Retinopathy and Other Ocular Findings in Primary Care Settings. Telemed J E Health 2018; 25:802-807. [PMID: 30481134 DOI: 10.1089/tmj.2018.0016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: To determine the incidence of diabetic retinopathy (DR) and other ocular findings in previously diagnosed diabetes using telehealth retinal screening with nonmydriatic fundus photography (nFP) in primary care physicians' offices. Methods: A retrospective study based on electronic chart review was performed. All diabetic patients who participated in the Wills Eye Hospital (WEH) telehealth retinal screening program from July 1, 2012 to February 20, 2017 were included. In addition to evaluation of DR, other eye pathologies of the retina were detected using nFP. Results: Overall, 9,946 diabetics participated in the WEH telehealth screening system. After exclusion of missing or unreadable images, 15,180 eyes of 7,624 (76.7%) patients were eligible for final analysis. A total of 1,269 (16.6%) patients were noted to have DR changes in at least one eye. Of those, 475 (37.4%) had mild nonproliferative DR (NPDR) in the more severely affected eye, 712 (56.1%) had moderate NPDR, 33 (2.6%) had severe NPDR, 19 (1.5%) had proliferative DR, and 30 (2.4%) have received pan-retinal photocoagulation previously. In addition, there was evidence of diabetic macular edema detectable on nFP in 34 eyes of 29 patients. Other ocular findings included hypertensive retinopathy (709, 9.3%), increased or asymmetric cup-to-disc ratio (562, 7.4%), age-related cataract (379, 5.0%), cotton-wool spots (221, 2.9%), choroidal nevus (74, 1.0%), age-related macular degeneration (AMD) (66, 0.9%), and epiretinal membrane (48, 0.6%). Patients with hypertensive retinopathy, glaucomatous findings, cataract, or AMD were significantly older (p < 0.001) than those without these ocular pathologies. Conclusion: The WEH Telehealth Screening Program identified DR in approximately one out of six patients and other ocular pathologies in over 25% of the diabetic population that received screenings in Philadelphia area primary care offices. Given the importance of early detection and routine eye care to prevent vision loss for DR patients, these findings have a significant impact.
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Affiliation(s)
- Xinxiao Gao
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.,Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Carl H Park
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Krista Dedrick
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Durga S Borkar
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anthony Obeid
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Shae Reber
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jay Federman
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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