June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Integrating Automated Preschool Vision Screening into the Medical Home
Author Affiliations & Notes
  • Saif Hamdan
    Vanderbilt University School of Medicine, Brentwood, Tennessee, United States
  • Natalia Gabriela Morales
    Vanderbilt University School of Medicine, Brentwood, Tennessee, United States
  • Stephanie H. Jian
    Vanderbilt Eye Institute, Nashville, Tennessee, United States
  • Kathryn Carlson
    General Pediatrics, Vanderbilt Children's Hospital, Nashville, Tennessee, United States
  • Merrill Stoppelbein
    General Pediatrics, Vanderbilt Children's Hospital, Nashville, Tennessee, United States
  • Sean Donahue
    Vanderbilt Eye Institute, Nashville, Tennessee, United States
  • Footnotes
    Commercial Relationships   Saif Hamdan, None; Natalia Morales, None; Stephanie Jian, None; Kathryn Carlson, None; Merrill Stoppelbein, None; Sean Donahue, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 242. doi:
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    • Get Citation

      Saif Hamdan, Natalia Gabriela Morales, Stephanie H. Jian, Kathryn Carlson, Merrill Stoppelbein, Sean Donahue; Integrating Automated Preschool Vision Screening into the Medical Home. Invest. Ophthalmol. Vis. Sci. 2020;61(7):242.

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

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Abstract

Purpose : The USPSTF recommends screening children for amblyopia and associated risk factors at ages 3 to 5 years old, and possibly even sooner. Challenges to implementing such programs in the medical home include coordinating referrals to eye care providers and follow-up. We describe a sustainable and replicable vision screening model that addresses these barriers.

Methods : In September 2018, the Vanderbilt Pediatric Primary Care Clinic (VPPCC) began automated photoscreening at 18 month and 3 year well child check visits. These visits were chosen because they have fewer required elements, allowing for integration of screening into workflow; photoscreening was added to the 4 years check later due to barriers in compliance at that age. We utilize a handheld, digital photoscreener (the PlusoptiX S12C) with electronic data storage and transfer via an SD card. Team members include providers, nurses and a referral coordinator.

Prior to patient visits, providers place an automated order set to flag children for screening, which is performed by trained nurses during intake. A failed vision screening (FVS) triggers a Best Practice Advisory in the electronic medical record, which automatically sets up the referral order, adds “FVS” as a visit diagnosis, and auto-populates a plan in the clinic note. All referrals are sent to an in-house referral coordinator, who contacts the patient’s family and helps schedule an appointment with a Vanderbilt ophthalmologist or optometrist.

Photoscreening completion and referral rates are monitored weekly through a report generated through the electronic medical record.

Results : From April 2019 to November 2019, 1915 children were screened (on average, 70.9 children/week). The referral rate during this time was 28.5%. An in-house coordinator, who is familiar with the clinic patients, allowed for closed-loop communication during referral scheduling and follow-up. Billing used CPT code 99177; the aggregate amount of reimbursement for photoscreening since September 2018 has been $32,000.

Conclusions : An integrated automated photoscreening model that incorporates a best practice advisory in the EMR at this clinic represents an effective model that can be replicated by other primary care pediatric offices. This efficient and cost-effective approach allows primary care providers to keep up with the increasing burden of vision screening recommendations.

This is a 2020 ARVO Annual Meeting abstract.

 

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