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Factors Influencing Utilization of a Diabetic Retinopathy Assessment Program

Diabetic Retinopathy Assessment. Our approach to the public health problem of diabetic retinopathy assessment in US:Fundus imaging at point of contact in primary care setting utilizing telemedicine technologyRequires low cost and easy to use technology with a remote reading center for image interp

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Factors Influencing Utilization of a Diabetic Retinopathy Assessment Program

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    1. Factors Influencing Utilization of a Diabetic Retinopathy Assessment Program Ingrid Zimmer-Galler, MD Johns Hopkins Wilmer Eye Institute Kevin Quinn, BS EyeTel Imaging, Inc. Ran Zeimer, PhD Johns Hopkins Wilmer Eye Institute

    2. Diabetic Retinopathy Assessment Our approach to the public health problem of diabetic retinopathy assessment in US: Fundus imaging at point of contact in primary care setting utilizing telemedicine technology Requires low cost and easy to use technology with a remote reading center for image interpretation

    3. DigiScope System Internet-based semi-automated digital retinal camera Placed in primary care physician’s office Minimal training Estimates visual acuity Validated Mydriatic

    4. DigiScope System DigiScope data auto- matically transmitted to reading center via Internet Secure encrypted data transfer Data reviewed by trained and certified readers under supervision of a retina specialist Report regarding need for referral to ophthalmologist returned to primary care office

    5. DigiScope System Referral Criteria No Referral: Minimal or no DR Referral: DR more than few microaneurysms and hemorrhages (or other non-DR findings) Urgent Referral: Sight-threatening disease (SNPDR, PDR, exudates suggesting macular edema) Patients with unreadable images are automatically referred

    6. Urgent Referral

    7. Urgent Referral

    9. DigiScope System Implemented at 233 primary care sites in 17 states 52,976 patient imaging sessions to date 27 sites with system in place for more than 5 years Only patients with diabetes who have not been evaluated by an eye care provider in past 12 months are imaged

    10. Purpose To determine factors associated with successful implementation (increased utilization) of the DigiScope diabetic retinopathy assessment program in the primary care environment

    11. Methods Review system utilization (number of patients imaged) during the study period at each site Evaluate factors that influence utilization of the DigiScope system at each site

    12. Results July 1, 2005 – December 31, 2005 DigiScopes implemented in 88 primary care sites (14 states) 5,044 patients with diabetes imaged Patients imaged per site ranged from 9 to 177 Average 2 to 30 patients imaged per month

    13. Results

    14. Results Financial viability (must image at least 4 patients per month) 88% (77/88) of sites Lower utilization associated with higher unreadable rate Top 10 sites 5.8% unreadable Bottom 10 sites 11.7% unreadable

    15. Results Number of patients with diabetes in practice: Top 10 sites 1,630 Bottom 10 sites 668 Reimbursement for imaging by health care insurance plans (>80% of patients): 10 of top 10 sites 6 of bottom 10 sites

    16. Results Factors associated with increased utilization: Involvement in quality health care initiatives (HEDIS, Bridges to Excellence, etc.) Integrated patient workflow (written protocol in place) Acceptance by office staff

    17. Results Factors associated with poor utilization: Poor ancillary staff acceptance Poor integration of procedure into office workflow Perceived poor economic return

    18. Conclusions Identification of factors associated with higher utilization of the DigiScope system may allow more appropriate implementation of the system with the goal of achieving a positive impact on overall diabetic retinopathy assessment rates

    19. Acknowledgements Supported in part by the Wilmer Telemedicine Fund (IZG), NEI R01 EY017053 (IZG, RZ) and NEI P30 EY01765 (Bethesda, MD) core grant (Wilmer Eye Institute) IZG and RZ serve on the EyeTel Imaging, Inc. Medical Scientific Advisory Board Under a licensing agreement between EyeTel Imaging, Inc. and the Johns Hopkins University, RZ is entitled to a share of royalty received by the University on sales of the DigiScope which is subject to certain restrictions KQ is employed by EyeTel Imaging, Inc.

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