An initiative to improve follow‐up of patients with diabetic retinopathy

Abstract

Background This study describes the implementation of an electronic medical record (EMR)‐based initiative aimed at identifying and reducing the number of patients with diabetic retinopathy (DR) lost to follow‐up (LTF). Method Providers were enlisted to review the EMRs and re‐engage patients with DR seen 1 year prior and who had not returned for care within the past 6 months. Binary logistic regression analysis was used to identify demographic, clinical and sociomedical factors associated with being LTF, as well as those predictive of re‐engagement. Results Out of 673 patients with DR, 78 (12%) were identified as LTF. Patients LTF were more likely to be younger (p = 0.001) and have poorly controlled haemoglobin A1c (HbA1c ≥ 8%, p = 0.04) and cholesterol (LDL ≥ 100 mg/dL, p < 0.001) levels. These patients were also more likely to have completed fewer ophthalmology appointments (p < 0.001), and less likely to have had retinal imaging within the last year (p < 0.001). Charts reviewed 1 month after the EMR‐based initiative revealed that 22 patients (28%) had been successfully re‐engaged by providers, while 56 patients (72%) remained LTF. History of prior treatment for DR was associated with re‐engagement by providers (p = 0.04). One month following the provider‐based intervention, the LTF rate dropped to 8.3%, and by 1 year only 3.6% of the patients remained LTF. Conclusions Electronic medical record‐based tools can successfully identify DR patients as being LTF, offering an opportunity for providers to re‐engage patients in a timely manner. Future studies are needed to determine the long‐term impact of patient re‐engagement on DR outcomes and efficiency of clinical practice.

Factors associated with loss to follow‐up in patients with advanced age‐related macular degeneration: A telehealth recall initiative

“…Coding variation is a major concern in database analyses 34 . This limitation was addressed by conducting a detailed chart review to enhance the accuracy of the clinical classification of each patient identified for outreach 23–25 . Despite finding a strong association between age and becoming LTFU, none of the other characteristics investigated here predicted which patients were more likely to be reached or accept a return to eye care when contacted.…”

“…Our outreach programme successfully reduced the LTFU rate by considering patient outcomes. Previous telehealth studies targeting patients with open‐angle glaucoma or diabetic retinopathy achieved higher success rates in returning patients to eye care 22–25 . This may be attributed, in part, to the younger age of patients with those conditions compared to advanced AMD.…”

“…34 This limitation was addressed by conducting a detailed chart review to enhance the accuracy of the clinical classification of each patient identified for outreach. [23][24][25] Despite finding a strong association between age and becoming LTFU, none of the other characteristics investigated here predicted which patients were more likely to be reached or accept a return to eye care when contacted. The definition of LTFU used in this study may also have inadvertently selected patients who faced more serious or insurmountable barriers to returning for care.…”

“…Previous telehealth studies targeting patients with open-angle glaucoma or diabetic retinopathy achieved higher success rates in returning patients to eye care. [22][23][24][25] This may be attributed, in part, to the younger age of patients with those conditions compared to advanced AMD. While the goal was to achieve a higher return rate for in-person eye care, contacting patients, including through a family member or healthcare proxy, fulfils the obligation to provide continued care.…”

“…1 This study sought to identify factors associated with becoming lost to follow-up (LTFU) among patients with advanced AMD, encompassing both wet and dry forms of the disease, and evaluated the effectiveness of reintroducing patients to care through outreach conducted by a telehealth extender. While prior studies have demonstrated that telephone-based outreach reduced the LTFU rate for patients with diabetic retinopathy or open-angle glaucoma, [22][23][24][25] reengaging patients overdue for follow-up care with AMD has not been previously investigated.…”