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Loren Lock, Roomasa Channa, Meghan Brennan, Ying Cao, CHRISTIANA FOWLKES, Yao Liu; Analysis of Health System Effect on Diabetic Eye Screening Variability in Rural Versus Urban Underserved Primary Care Clinics. Invest. Ophthalmol. Vis. Sci. 2022;63(7):561 – A0126.
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© ARVO (1962-2015); The Authors (2016-present)
Rural and urban underserved communities experience lower rates of preventive screening, but factors contributing to variability in diabetic eye screening receipt between these communities have not been systematically analyzed. We used a unique, all-payer database covering over 75% of Wisconsin residents (Wisconsin All-Payer Claims Database) to assess factors associated with screening variability in rural vs. urban underserved and advantaged primary care clinics.
We included adults with diabetes (18-75 years old) with claims billed throughout the baseline (2012-2013) and measurement years (2013-2014). Patients received screening if they had a claim billed for an exam with an eye care provider or telemedicine-based retinal imaging during the measurement year. We created multivariable logistic regression models to assess the impact of age, gender, hierarchical condition category risk score, health system, primary care clinic rurality, and level of disadvantage (following the Wisconsin Collaborative for Healthcare Quality classification) on screening receipt.
A total of 118,707 adults with diabetes from 143 Wisconsin health systems were included. Most (74%) were over 55 years of age (mean: 61 ± 11 years), male (51%), and obtained care from urban primary care clinics (84%). Screening rates varied widely from 32% to 72%, with the least screening among those obtaining care from urban underserved primary care clinics and the greatest screening among those obtaining care from urban advantaged primary care clinics. Before adjusting for health system in the model, and with urban advantaged primary care clinics serving as the reference, patients who obtained care from rural vs. urban underserved primary care clinics were more likely to obtain screening (ORrural 0.79, 95% CI 0.71-0.88 vs. ORurban 0.60, 95% CI 0.58-0.63). However, patients from urban underserved clinics were more likely than their rural counterparts to obtain screening after adjusting for health system (ORrural 0.72, 95% CI 0.62-0.82 vs. ORurban 0.89, 95% CI 0.84-0.94).
There was significant variability in screening based on primary care rurality and level of disadvantage. Health system contributed substantially to this variability. Health system-focused interventions, particularly those serving patients in urban underserved primary care clinics, may increase screening receipt.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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