From the 2021 HVPAA National Conference
Huda Al-Bahadili (Piedmont Athens Regional), Zahraa Rabeeah
Diabetic retinopathy (DR) is a progressive microvascular complication of diabetes mellitus. It affects almost one-third of adults over the age of 40, making it the leading cause of preventable blindness in US adults. The 2017 American Diabetes Association Guidelines recommends bi-annual screening for DR. American Academy of Ophthalmology identified that only 50-65% of patients receive the recommended screening in clinical practice. According to CDC, diabetes-related blindness costs more than $500 million annually. Over the past 2 decades, the incidence of visual loss from DR declined by 6.5%. The decline was attributed to improved glycemic control, DR screening, early detection and treatment. A baseline retrospective study was conducted at Piedmont Athens Regional (PAR) Residents’ Clinic from May 2016 to May 2017. The study showed that the rate of referral for DR screening was 21.1%. Barriers leading to suboptimal screening rates were identified, some of which were lack of health insurance. Free in-house Ophthalmology clinic was successfully established through a grant, with the aim to increase DR screening by 10% in one year. This quality improvement project is a follow-up study to assess the impact of free in-house ophthalmology clinic on DR screening.
We conducted a retrospective chart review of patients with diabetes seen at PAR Residents’ clinic between July 2019 and February 2020. Accordingly, 850 charts met our inclusion criteria. This was patients with diabetes age 25 or older. The exclusion criteria consisted of patients with diabetes who were not seen more than twice by a resident physician at PAR Residents clinic in the past 2 years. Charts were gathered in an excel sheet which included HbA1c level, insurance status, race, referral and DR documentation, if present. Categorical data was analyzed in percentages.
The data shows the clinic’s referral rate is 47.2%. Out of those referred, 45.7% completed a dilated eye exam and 42% were uninsured. In addition, 9.3% had their DR screening done at PAR residents’ clinic with a complete documentation of the dilated eye exam in their charts. Out of those who completed their dilated eye exam, 8.2% had DR per ophthalmologist’s documentation.
Establishing a free in-house ophthalmology clinic has clearly increased the referral rate and has improved DR screening in PAR residents’ clinic patient population. Additional efforts are being made to individualize referral rates per provider, purchase a non-mydriatic retinal camera with IDx-DR software and establish a standardized subspecialty referral navigator, to further improve DR screening at the residents’ clinic in addition to rates of completed dilated retinal exam.