Utilization of Remote Diabetic Retinal Screening in a Suburban Healthcare System

Abstract

Purpose We conducted a cross-sectional study to assess the utilization of a tele-ophthalmology screening program in a low-risk, suburban population of patients with diabetes. Methods A total of 214 diabetic patients without previously documented diabetic retinopathy (DR) underwent point-of-care non-mydriatic fundus photography through their primary care providers at five Beth Israel Lahey Health locations. The characteristics of the patients who received remote screening were compared with those patients who were eligible for screening but did not take part in the program. Time-driven activity-based costing (TDABC) was implemented to examine the cost of screening by tele-ophthalmology compared with in-person examinations. Results Tele-ophthalmology screening was more likely to be provided for patients who were younger (OR 0.985; 95% CI 0.973–0.997, p =0.016), who were obese (OR 2.04; 95% CI: 1.47–2.84, p =0.008), who had an HbA1c above 8.0% (OR 1.60; 95% CI: 1.13–2.26, p =0.031), or who had an eye examination in the past year (OR 5.55; 95% CI: 3.89–7.92, p <0.001). Those patients newly diagnosed with DR because of the program were more likely to have diabetic nephropathy (OR 7.79; 95% CI: 1.73–35.05, p =0.007). TDABC identified a health system cost-savings of between $8 and $29 per patient screened by tele-ophthalmology compared with the cost of in-person eye examinations. Conclusion Tele-ophthalmology presents an opportunity to reduce the costs of screening patients without prior evidence of DR, especially those who have completed a comprehensive eye examination within the prior year.

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

“…Not surprisingly, patients who had completed recent primary care visits, or who had up‐to‐date HbA1c or microalbumin testing, had an increased likelihood of following up with their eye care providers. This reinforces the premise that primary care offices are the point of entrance for many preventative health services, with primary care providers making referrals and coordinating many diabetic patients' care 18,20 . While patients who had recent HbA1c testing were significantly less likely to be LTF for retinal care in our study (40% vs. 60%, p < 0.001), as measured against the recommended frequency of such testing, 6,21 there is either a notable shortfall in testing, or test data is not being communicated to ophthalmologists.…”

“…This reinforces the premise that primary care offices are the point of entrance for many preventative health services, with primary care providers making referrals and coordinating many diabetic patients' care. 18,20 While patients who had recent HbA1c testing were significantly less likely to be LTF for retinal care in our study (40% vs. 60%, p < 0.001), as measured against the recommended frequency of such testing, 6,21 there is either a notable shortfall in testing, or test data is not being communicated to ophthalmologists. Finally, having more frequent ophthalmology follow-up visits or receiving retinal imaging in the prior year were both associated with a lower likelihood of being LTF.…”

Patient adherence to therapy after switch to aflibercept from bevacizumab or ranibizumab for treatment-refractory neovascular age-related macular degeneration

“…[ 17 ] When aflibercept and bevacizumab were initially compared, strict clinical trial protocols were in place to optimize patient compliance with treatment, including receiving the help of study coordinators, study-provided medications, and other incentives for participation. [ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ] However, patients undergoing treatment for nAMD must contend with real physical,[ 20 21 ] psychological,[ 6 20 22 ] and financial[ 23 24 ] burdens associated with treatment. These burdens can often influence a patient's ability to comply with recommended treatment protocols.…”

“…[ 15 ] The approximate distance to the clinic for each patient was computed by using an Excel VBA program to access Microsoft Maps, which calculated the number of miles between each patient's home and the clinic by zip code, as previously described. [ 16 ]…”

Comparison of Incremental Costs and Medicare Reimbursement for Simple vs Complex Cataract Surgery Using Time-Driven Activity-Based Costing

“…In recent years, it has become a popular methodology for measuring the costs of surgical procedures and has been increasingly used within the field of ophthalmology. Some have used TDABC to address cost differences and potential savings of teleophthalmology, [8][9][10] while others have aimed to improve operational efficiency. 11,12 One prior study argued that true costs may exceed reimbursement for elective vitrectomy, highlighting the use of TDABC to compare costs with reimbursement.…”