Abstract
Purpose: :
To improve the rate of annual retinal exams in patients with diabetes within the Henry Ford Health System (HFHS).
Methods: :
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. The first task was to determine the accuracy of the baseline 2005 HEDIS score using hybrid method analysis, combining administrative claims data and medical record review to verify exam completion. Shifting focus to the 2006 HEDIS score, the group examined the HAP database for individuals requiring an eye exam in 2005. The committee then initiated an educational campaign for senior staff, residents, fellows, and mid–level providers by means of an electronic mailing describing the eye exam initiative. Next, a patient mailing campaign was developed to contact unscreened patients. The list of unscreened patients was cross–referenced against claims data and electronic medical records. Patients were organized by nearest geographic medical care site and then sub–grouped into one of three categories. Patients in Group 1, composed of one site, received a personalized letter from their internist regarding the initiative. Persons in Group 2, consisting of four sites, received two mailings: a postcard and a generic letter co–signed by the medical director of the insurance plan and the chairman of the department of Ophthalmology. Finally, those patients within the remaining 19 sites composing Group 3 received only the generic letter. A telephone campaign followed to reach those persons who did not respond to the original mailing; outgoing calls began approximately two months after the initial mailings. Data collection consisted of tracking incoming patient inquiries, outgoing telephone responses, and claims data.
Results: :
A total of 6,195 patients of 14,000 HFHS HAP patients needed screening in 2005. The total number of completed screenings is 996 patients (16.1%). The sub–group total number screened results are as follows: Group 1 – 104 (25.2%), Group 2 – 371 (15.8%), and Group 3 – 521 (15.5%). Collective telephone data reveals 127 patients as non–diabetic and three as deceased; calls resulted in 532 newly scheduled appointments.
Conclusions: :
The quality improvement team approach to improving the eye exam rate is effective; we were able to raise our screening percentage to an estimated 63%. Multiple obstacles in the mail and telephone campaigns as well as evident patient apathy toward the goals of the initiative suggest that a campaign for the public education on the importance of annual diabetic eye exams may be required.
Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials