June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Evaluation and referral of diabetic eye disease within the endocrinology and primary care office setting: A quality improvement project
Author Affiliations & Notes
  • Fabiana Queiroga de Paula Araujo Silva
    Ophthalmology, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Touka Banaee
    Ophthalmology, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Leann Olansky
    Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • M. Cecilia Lansang
    Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Rishi P Singh
    Ophthalmology, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Fabiana Silva, None; Touka Banaee, None; Leann Olansky, None; M. Cecilia Lansang, None; Rishi Singh, Alcon (F), Apellis (F), Genentech (C), Genentech (F), Optos (C), Regeneron (C), Regeneron (F), Shire (C), Zeiss (C)
  • Footnotes
    Support  Regeneron educational grant
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 96. doi:
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      Fabiana Queiroga de Paula Araujo Silva, Touka Banaee, Leann Olansky, M. Cecilia Lansang, Rishi P Singh; Evaluation and referral of diabetic eye disease within the endocrinology and primary care office setting: A quality improvement project. Invest. Ophthalmol. Vis. Sci. 2017;58(8):96.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To identify whether endocrinologists and primary care physicians (PCP) adequately screened for ophthalmic symptoms/signs of diabetic retinopathy (DR) within office visits and provided timely ophthalmology referrals in patients with diabetes (DM) after quality improvement (QI) measures were taken.

Methods : The primary study assessed screening of DR at the primary care level in a tertiary care institution in the year of 2014 through evaluation of electronic charts. It showed that endocrinologists and PCPs assessed ophthalmic symptoms/signs in 95.5% and 71% of DM patients, respectively (p<0.0001). QI measures including a webinar, two live programs and a CME roundtable were performed to improve the screening process in the primary diabetes care settings. In order to verify if there was improvement after the QI interventions, an electronic chart review was performed for patients from 18-80 years old seen by endocrinologists and PCPs after June 1st, 2016. Demographic data and patients` biochemical status were collected. To evaluate the ophthalmic assessments, electronic charts were reviewed for the key search terms, which were graded as either 0=not identified, 1=asked about by the clinician, or 2=examined by the clinician during the encounter. To verify the referral of DM patients to ophthalmic evaluation, one encounter with an endocrinologist or PCP was chosen randomly for each patient and the number of days since the last ophthalmic examination for diabetes was calculated.

Results : A total of 600 patient records were reviewed. The mean age at encounter was 60.2 ± 13.2 years old and 52.5% of patients (n=315) were female. Provider asked about ophthalmic symptoms/signs in 88.3% (n=265) and 61.3% (n=184) of endocrinology and PCP office encounters, respectively (p<0.0001). Past and/or future ophthalmology appointments were verified in 78.7% (n=236) and 43% (n=129) of patients during endocrinology and PCP visits, respectively (p<0.0001). The mean number of days since the last ophthalmic examination was 53.2 ± 40.8 days for endocrinologists and 55.2 ± 37.3 days for PCPs (p=0.77). Table 1

Conclusions : Ophthalmic complications from diabetes are still not adequately screened, especially within the primary care setting. This QI project involving directed medical education to physicians resulted in improvements in the referral of DM patients to ophthalmic evaluation.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

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