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M. Jancevski, P. A. Edwards; Diabetes Retinopathy Screening Quality Improvement Team Initiative: Success Through Change. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1369.
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To improve the rate of annual retinal exams in patients with diabetes within the Henry Ford Health System (HFHS).
A multi-specialty quality improvement committee convened to formulate and implement plans to improve the rate of screening for retinopathy in patients of the Health Alliance Plan (HAP), a wholly owned insurance subsidiary of the HFHS. Through a combined patient mailing campaign and subsequent follow-up telephone campaign that began in 2005, patients were encouraged to complete their annual dilated diabetic evaluations. The original campaign was modified in succeeding years. In 2006, mailings and telephone contact were implemented on a quarterly basis moving from annual notifications. Then in 2007, one individual educated in the importance of annual retinopathy screenings was allocated to solely make all outgoing telephone calls to patients.
A total of 6,195 patients of 14,000 HFHS HAP patients needed screening in 2005. At year's end,a total of 1,477 (23.8%) patients completed screening as part of the quality initiative. In 2006, there were 13,009 HFHS HAP patients with diabetes. By the end of the year, 7,450 patients received screenings. In July 2007, there were a total of 12,940 HFHS HAP patients with diabetes, with 5,461 patients needing screening. At the completion of the 2007 initiative, an additional 4,398 of these patients completed screening.
The quality improvement team approach to improving the eye exam rate demonstrated efficacy, raising the diabetic retinopathy screening percentage to an estimated 66.3% in its initial year. However, such measures failed to show continued adherence to annual diabetic screenings the following year, despite multiple reminders. After employment of a sole educated caller, the rate of successful screenings rose to 90.8%. Such an individual can adequately field patient questions, possibly reflecting the importance of the educational element to screening adherence.
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