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M. Jancevski, P. A. Edwards, G. Trick; Diabetes Retinopathy Screening Quality Improvement Team Initiative: Will the Success Continue?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2139. doi: https://doi.org/.
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To compare and contrast patients within the Henry Ford Health System (HFHS) targeted in the Diabetic Retinopathy Screening Quality Improvement initiative who successfully completed a 2005 dilated retinal screening in regard to potential characteristics that may influence completion of a follow-up examination in the subsequent calendar year.
A multi-specialty quality improvement committee convened to formulate and implement plans to improve the rate of screening for retinopathy for patients of the Health Alliance Plan (HAP), a wholly owned insurance subsidiary of the HFHS. Through a combined mailing campaign and subsequent follow-up telephone campaign, patients were encouraged to complete their annual dilated diabetic evaluations. At the completion of 2005, a total of 1,477 patients completed their screenings from the original 6,195 targeted patients. A consecutive electronic medical chart review examined these successfully screened patients. Patients were subdivided into those completing diabetic evaluation in 2006 and failing to complete a diabetic retinopathy screening examination the following calendar year. These sub-groups were compared in terms of age, gender, and race demographics. Further group comparisons included levels of hemoglobin A1C, insulin dependence, visual acuity, staging of diabetic retinopathy at the 2005 evaluation, and treatment intervention.
A total of 6,195 patients of 14,000 HFHS HAP patients needed screening in 2005. At the completion of 2005, a total of 1,477 (23.8%) patients completed screening as part of the quality initiative. A total of 343 electronic chart reviews were performed; only 206 (60%) patient charts identified a dilated retinal examination. The sub-groups consisted of 92 patients failing to demonstrate a 2006 diabetic retinopathy screening and 114 patients with a qualifying 2006 evaluation. Age, gender, and race were similar between the groups. Variables including type of diabetes, insulin usage, visual acuity, retinopathy stages, and treatment failed to demonstrate any statistically significant differences between sub-groups.
The quality improvement team approach to improving the eye exam rate demonstrated efficacy, raising the diabetic retinopathy screening percentage to an estimated 66.3%; however, such measures failed to show continued adherence to annual diabetic screenings the following year. While multiple obstacles exist, the most concerning remains patient apathy toward the initiative goals suggesting that a campaign for the public education on the importance of annual diabetic eye exams may be required.
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