Effectiveness and efficiency of tele-expertise for improving access to retinopathy screening among 351 neonates in a secondary care center: An observational, controlled before-after study

Abstract

In France, secondary care hospitals encounter difficulties to adhere to retinopathy of prematurity (ROP) screening guidelines. Our objective was to assess the effectiveness and efficacy of a tele-expertise program for ROP screening in neonatal intensive care units without on-site ophthalmologists. We evaluated the impact of a tele-expertise program funded by the Paris Region Health Authority in a secondary care center general hospital of the Paris Region (CHSF), where there was previously no on-site ophthalmologist. We performed an observational, controlled before-after study, with a university tertiary care center with on-site ophthalmologists (Port-Royal) as the control group. Recruitment and data collection for both periods took place from 1 January 2012 to 31 December 31 2012, and from 1 January 2014 to 31 March 2015. The primary endpoint was the percentage of compliance with screening guidelines, secondary endpoints included pain scores and costs. Over the two periods, at total of 351 infants were recruited in the CHSF. Implementation of the tele-expertise resulted in an absolute +57.3% increase in the proportion of examinations realized in accordance with guidelines (3.8% during the "before" period and 61.1% during the "after" period, p<0.001). As compared with the control group, the proportion of infants appropriately screened improved (57.5% versus 43.1%, p = 0.002); median pain score on the acute pain rating scale for neonates during examination was significantly higher (median score 5.5/10, range [2.5–5.7] versus 2.0/10, range [1.0–3.1], p = 0.002). Screening rates in the control group remained unchanged. The average cost per examination increased from €337 in the "before" period to €353 in the "after period" in the tele-expertise group. The implementation of tele-expertise for ROP screening in the CHSF medical center resulted in a major improvement of access to care with a small cost increase. The issue of pain control during examination with tele-expertise should be further addressed.

Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition

“…In France, implementation of a telemedicine program for ROP screening resulted in an absolute 57.3% increase in the proportion of examinations completed in accordance with American Academy of Pediatrics guidelines, whereas the screening rates in the control group, which continued ROP screening using live examinations, remained unchanged. 258 The average cost of examination in the telemedicine program was slightly more expensive (*$22) than the standard procedure of transferring infants to a specialized center for examination by a specialist, but the authors projected that this cost would decrease as the number of examinations completed rose. 258 Another French ROP screening program was conducted in Bordeaux between July 2009 and August 2015 and screened 419 infants using the RetCam 120.…”

“…258 The average cost of examination in the telemedicine program was slightly more expensive (*$22) than the standard procedure of transferring infants to a specialized center for examination by a specialist, but the authors projected that this cost would decrease as the number of examinations completed rose. 258 Another French ROP screening program was conducted in Bordeaux between July 2009 and August 2015 and screened 419 infants using the RetCam 120. 259 They found any ROP in 27.68% of infants.…”

Telemedicine for Retinopathy of Prematurity

“…In France, implementation of a telemedicine program for ROP screening resulted in an absolute 57.3% increase in the proportion of examinations completed in accordance with American Academy of Pediatrics guidelines, whereas the screening rates in the control group, which continued ROP screening using live examinations, remained unchanged. 41 The average cost of examination in the telemedicine program was slightly more expensive (*$22) than the standard procedure of transferring infants to a specialized center for examination by a specialist, but the authors projected that this cost would decrease as the number of examinations completed rose. 41 Another French ROP screening program was conducted in Bordeaux between July 2009 and August 2015 and screened 419 infants using the RetCam 120.…”

“…41 The average cost of examination in the telemedicine program was slightly more expensive (*$22) than the standard procedure of transferring infants to a specialized center for examination by a specialist, but the authors projected that this cost would decrease as the number of examinations completed rose. 41 Another French ROP screening program was conducted in Bordeaux between July 2009 and August 2015 and screened 419 infants using the RetCam 120. 42 They found any ROP in 27.68% of infants.…”

The use of telemedicine to support Brazilian primary care physicians in managing eye conditions: The TeleOftalmo Project

“…[21][22][23] These initiatives are usually intended to screen a specific disease in a high-risk population-for instance, diabetic retinopathy in diabetic patients [24,25] and retinopathy of prematurity in premature newborns. [26,27] The TeleOftalmo project, on the other hand, is dedicated to comprehensive eye-checks and providing glass prescription. This is particularly important in our setting due to unmet demand for ophthalmological visits, as discussed above.…”