Abstract
Purpose :
The prevention of vision loss from diabetic retinopathy (DR) calls for effective surveillance by means of examination of the fundus performed at least annually, but adherence to that standard is alarmingly low. We conducted a cross-sectional, electronic health record (EHR)-based study to identify factors associated with completion of annual diabetic eye examinations in a primary care population.
Methods :
A retrospective review of established patients who had diabetes and were between the ages of 18 to 75 was conducted. Patient demographics, clinical characteristics, status of patient portal (MyChart) registration, and Healthcare Effectiveness Data and Information Set (HEDIS) metrics were extracted from the EHR using a custom reporting tool. Logistic regression analysis was used to assess the relationship between these variables and the completion of a diabetic eye examination within a one-year study period.
Results :
Out of 19,902 patients with diabetes, 35% were documented to have completed an annual eye examination during 2021. Characteristics associated with adherence to the eye examination included having an active MyChart account (OR: 1.935, CI: 1.780-2.102, p<0.001) or registering for the patient portal (OR: 1.523, CI: 1.347-1.721, p<0.001), having DR (1.788, CI: 1.611-1.985, p<0.001), and completing microalbumin testing within the last year (OR: 1.516, CI: 1.404-1.637, p<0.001). MyChart had the strongest association with 85% of people who had MyChart also completing an eye examination. On the other hand, smoking (OR: 0.793, CI: 0.713-0.882, p<0.001), identifying a language other than English as one’s primary language (OR: 0.781, CI: 0.656-0.930, p<0.001), and being uninsured (OR: 0.022, CI: 0.003-0.161, p<0.001) were characteristics associated with decreased adherence. Completion of an annual eye examination was not related to race, sex, BMI, or having Type 1 diabetes.
Conclusions :
Our study finds that HEDIS metrics are interrelated. Closing gaps in one domain may, therefore, synergistically improve healthcare quality performance in other key domains. Although not all factors associated with the completion of a diabetic eye examination are capable of being modified, some are highly actionable. In particular, the promotion of digital health literacy by encouraging the utilization of MyChart may help patients to access eye care and become more engaged in their own healthcare decisions.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.