June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Diabetic Retinopathy Screening in Primary Care: Implementation for Sustained Impact in Teleophthalmology (I-SITE)
Author Affiliations & Notes
  • Alejandra Torres Diaz
    Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Loren Lock
    Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Todd Molfenter
    Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Jane E Mahoney
    Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Deann Boss
    Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Timothy D Bjelland
    Mile Bluff Medical Center, Mauston, Wisconsin, United States
  • Yao Liu
    Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Footnotes
    Commercial Relationships   Alejandra Torres Diaz, None; Loren Lock, None; Todd Molfenter, None; Jane Mahoney, None; Deann Boss, None; Timothy Bjelland, None; Yao Liu, None
  • Footnotes
    Support  NIH/NEI K23 EY026518 and an institutional grant from Research to Prevent Blindness to the University of Wisconsin-Madison Department of Ophthalmology and Visual Sciences
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1072. doi:
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      Alejandra Torres Diaz, Loren Lock, Todd Molfenter, Jane E Mahoney, Deann Boss, Timothy D Bjelland, Yao Liu; Diabetic Retinopathy Screening in Primary Care: Implementation for Sustained Impact in Teleophthalmology (I-SITE). Invest. Ophthalmol. Vis. Sci. 2021;62(8):1072.

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

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Abstract

Purpose : Teleophthalmology provides evidence-based diabetic retinopathy screening that is underused even when readily available in primary care clinics. There is an urgent need to increase teleophthalmology use in U.S. primary care clinics. In this study, we describe the development of a tailored implementation program to increase teleophthalmology use (I-SITE) and report outcomes related to primary care provider (PCP) adoption.

Methods : We applied the NIATx Model for healthcare process improvement to develop and test I-SITE in a rural, U.S. multi-payer health system. We hypothesized that teleophthalmology use would be higher among PCPs who did versus those who did not participate in various components of I-SITE. We also surveyed PCPs and clinical staff to identify implementation strategies they perceived to have the greatest impact on increasing teleophthalmology use.

Results : Teleophthalmology use was nearly 5-fold greater among PCPs participating in the I-SITE implementation team (n=3) than other PCPs (n=22, p < 0.001). The proportion of all PCPs who elected diabetic eye screening for their performance-based financial incentive increased from 0% (n = 0) at baseline to 56% (n = 14) following I-SITE implementation (p<0.001). PCPs who elected diabetic eye screening as a performance-based financial incentive referred nearly 5 times more patients for teleophthalmology each quarter than those who did not (7.4 vs. 1.5 referrals, respectively, p=0.06). There was a trend towards increased teleophthalmology referrals following audit and feedback presentations at regularly-scheduled staff meetings (p=0.16). PCPs and clinical staff reported the following implementation strategies to have the highest impact on teleophthalmology use: reminders to ask patients about diabetic eye screening during clinic visits, streamlining electronic health record (EHR) documentation, and patient outreach.

Conclusions : I-SITE provides a practical roadmap for tailored integration of teleophthalmology into primary care clinics and increasing teleophthalmology use (https://hipxchange.org/I-SITE). Implementation strategies effective for increasing provider adoption of teleophthalmology included enhancing perceived ease of use, participation in implementation, audit and feedback, and performance-based financial incentives.

This is a 2021 ARVO Annual Meeting abstract.

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