Ophthalmic care delivery in an academic health system for patients who were incarcerated or in immigration detention, 2018-2023

Abstract

Purpose : Ophthalmic care for incarcerated patients and those in immigration detention presents complex challenges to patients and providers. There remains a paucity of literature investigating disparities in care for these marginalized populations. Our study investigated the delivery of comprehensive and subspecialty ophthalmic care to incarcerated and detained patients in an academic health system.

Methods : 239 patients had 1027 visits that were attended, no-showed, or cancelled within the study period of 11/1/2018 to 9/30/2023. Demographic data, insurer, type of visit, diagnoses, and follow-up dates were extracted from the electronic health record (Epic; Verona, WI). Loss to follow-up (LTFU) was defined as a lack of follow-up visits with ophthalmologists in this health system after incarceration/detention or the end of the study period. Delays in care (i.e., differences between recommended and actual follow-up) were quantified for attended visits.

Results : Demographic details and insurers for the 239 patients are summarized in Table 1. Patients were mostly men (87%) and aged 44.4 ± 13.8 years. The most common presenting diagnoses were orbital wall fracture, glaucoma, and cataract (Table 2). 869 in-office visits (3.7 ± 4.7 per patient) were included; the remainder were ED consults, surgeries, and hospitalization follow-ups. 548 visits were recorded as attended, 191 canceled per clinic, 82 canceled per patient >24 hours in advance, and 48 no-shows or cancellations by patients <24 hours in advance. Patients experienced a delay of 14.6 ± 22.9 weeks between recommended and actual follow-up dates. 218 (91.2%) were lost to follow-up.

Conclusions : This study investigated delays in care and LTFU experienced by incarcerated and detained patients seen by ophthalmologists in an academic health system. Two limitations affected our ascertainment of cancellations and LTFU. Per-clinic cancellation numbers may be inflated: clinic staff initially mark all patients as having arrived and may record some no-shows as per-clinic cancellations. Also, our chart review did not capture if patients received follow-up ophthalmic care outside of this health system. Further research into delays in care and reasons for delays could give rise to specific targets for quality improvement initiatives.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Table 1. Demographic characteristics and insurers

 

Table 2. Most common presenting diagnoses