June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
An initiative to improve follow-up of patients with glaucoma
Author Affiliations & Notes
  • Calvin C Robbins
    Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States
    Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
  • Sidrah Anjum
    Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
    Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Amer Mosa Alwreikat
    Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
    Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Michael Lee Cooper
    Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
  • Paul Cotran
    Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
    Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Shiyoung Roh
    Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
    Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States
  • David J Ramsey
    Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
    Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Calvin Robbins, None; Sidrah Anjum, None; Amer Alwreikat, None; Michael Cooper, None; Paul Cotran, None; Shiyoung Roh, None; David Ramsey, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1617. doi:
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      Calvin C Robbins, Sidrah Anjum, Amer Mosa Alwreikat, Michael Lee Cooper, Paul Cotran, Shiyoung Roh, David J Ramsey; An initiative to improve follow-up of patients with glaucoma. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1617.

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

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Abstract

Purpose : Adherence to follow-up for glaucoma is known to be poor, especially among asymptomatic patients or those with mild disease. This study reports on an initiative aimed at reducing the number of patients with glaucoma-related diagnoses lost to follow-up (LTF) and reviews its short-term outcomes.

Methods : An electronic medical record (EMR)-based tool was designed to identify patients with glaucoma-related diagnoses who were seen at a hospital-based outpatient eye clinic within a six-month period in the prior year and who had not scheduled or returned for follow-up care. Providers were given lists of patients designated as potentially LTF and asked to review the EMR and re-engage patients, as appropriate. One month later, the initiative was evaluated by retrospective chart review.

Results : 3,666 unique patients were seen during the study period. 3,167 patients were not LTF (86.4%) and 115 patients were deceased (3.1%), leaving 384 patients as LTF (10.5%). The number of prior ophthalmology appointments attended was inversely related to the risk of being LTF (Pearson correlation r=-0.067, P<0.0001). Not surprisingly, history of missing a scheduled appointment increased the risk of being LTF (OR 1.51, 95% CI 1.22 to 1.86 p=0.0002). Patients with low-risk findings such as glaucoma suspects or ocular hypertensives were more likely to be LTF than those with other forms of glaucoma (OR 1.26, 95% CI 1.01-1.58, p=0.038). Patients with primary open angle glaucoma were less likely to be LTF than those with other glaucoma-related diagnoses (OR 0.77, 95% CI 0.62-0.95, p=0.016). One month following the re-engagement initiative, 124 (32.3%) of the LTF patients had been re-engaged: 49 had completed a telemedicine visit (39.5%), 70 had a new in-person appointment ordered or scheduled (56.5%), and 5 had documentation that they declined re-engagement when contacted (4.0%). Of the remaining 260 patients (67.7%) without documented re-engagement, an order to schedule a follow-up appointment had been submitted for 238 individuals (91.5%). At the end of the initiative, only 22 patients (5.7%) had no documented plan for follow-up.

Conclusions : An EMR-based reporting system can be an effective tool to alert providers and allow for the re-engagement of patients with glaucoma-related diagnoses at risk of being LTF. This should promote better management of glaucoma and related diagnoses, enhance clinical productivity, and reduce potential medicolegal liability.

This is a 2021 ARVO Annual Meeting abstract.

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