- Chronic Conditions
- Diabetes
- Dissemination and Implementation
- HIP Data
- HIPxChange
- Older Adults
- Prevention
- Quality and Safety
Lead Investigator
Areas of Impact
Overview
To prevent blindness, we have sustained an increase in diabetic eye screening by 36% at Mile Bluff Medical Center, a rural clinic in Mauston, Wisconsin, using our teleophthalmology implementation program (I-SITE: Implementation to Sustain Impact in Teleophthalmology). The program was expanded to UW Health primary care clinics in Madison, WI, Fort HealthCare in Fort Atkinson, WI, and Reedsburg Area Medical Center in Reedsburg, WI. They have engaged the interest of other healthcare organizations across Wisconsin, including Prairie Clinic, Marshfield Clinic, Gundersen, and SSM Health.
The Clinical Problem
Diabetic eye disease is the leading cause of blindness among working-age adults in Wisconsin, where there are currently over 135,000 adults with diabetes. Early screening and treatment can prevent 90% of blindness, but only half of adults with diabetes get their recommended yearly eye screening.
Our Response
Dr. Yao Liu, Assistant Professor in the Department of Ophthalmology and Visual Sciences at the University of Wisconsin School of Medicine and Public Health, established a teleophthalmology program in 2015 to increase diabetic eye screening.
Working in partnership with the Mile Bluff Medical Center, a rural health clinic in Mauston, WI, patients with diabetes are referred by their primary care provider (PCP) to get their eyes screened during a regular visit, in the same building, and without having to make a second trip or appointment. The images are sent to Madison and read by UW eye specialists who send reports back to the primary care clinic and to patients. Patients needing further clinical evaluation or treatment are then identified and referred to local eye doctors.
“I’m upstairs at the doctor’s office and he says maybe you should get this done… you walk downstairs… sit down for 10 minutes… you get it done and you go home… I mean, it’s so simple.” — Patient describing teleophthalmology
Dr. Liu conducted interviews with 20 patients with diabetes and 9 PCPs to understand patient and provider perspectives on the program, what has made it easier or harder to use teleophthalmology, and what next steps could be taken to help design solutions to increase screening rates.
Benefits to this Model
- Less than 2 minutes to image both eyes
- Dilating eye drops are usually not needed
- Low-cost service
- Camera located in the primary care clinic
- Rapid referrals for those needing treatment
Results
Diabetic eye screening rate increased by 36% at Mile Bluff in the first year after teleophthalmology was introduced, and almost all PCPs have referred one or more patients for teleophthalmology.
Patient interviews showed a preference for teleophthalmology over a traditional eye exam because it was quick and convenient, pupils didn’t need to be dilated, and their PCP recommended the screening. While many patients were not familiar with teleophthalmology, they felt that price, which was competitive with patient co-pays for other standard clinic visits or lab services, was a reasonable charge for the service.
Providers believed that the convenience of teleophthalmology improved patient adherence with screening, but they found it difficult to identify which patients were due for eye screening, and requested a reminder to ask patients with diabetes about eye screening.
Lasting Impact
The goal of this ongoing teleophthalmology program is to reduce preventable blindness among patients with diabetes in Wisconsin and reach 70% screening levels (90th percentile nationally).
The program continues work at Mile Bluff in collaboration with their newly established Diabetes Quality Care Team and Patient Advisory Council to design a primary care workflow to improve screening rates. They also receive guidance from an expert advisory panel, the Wisconsin Research and Education Network (WREN) Steering Committee.
We have expanded this program to UW Health clinics in the Madison area, Fort HealthCare in Fort Atkinson, WI, and Reedsburg Area Medical Center in Reedsburg, WI, which collectively serve over 20,000 patients with diabetes. We have engaged the interest of other partner healthcare organizations across the state of Wisconsin, including Prairie Clinic, Marshfield Clinic, Gundersen, and SSM Health.
References
- Liu Y, Torres Diaz A, Benkert R. Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA. Curr Diab Rep. 2019 Aug 2;19(9):74.
- Liu Y, Zupan NJ, Swearingen R, Jacobson N, Carlson JN, Mahoney JE, Klein R, Bjelland TD, Smith MA. Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic: a qualitative study. BMJ Open. 2019 Feb 18;9(2):e022594.
- Liu Y, Zupan NJ, Shiyanbola OO, Swearingen R, Carlson JN, Jacobson NA, Mahoney JE, Klein R, Bjelland TD, Smith MA. Factors influencing patient adherence with diabetic eye screening in rural communities: A qualitative study. PLoS One. 2018 Nov 2;13(11):e0206742.
- Liu Y, Swearingen R. Diabetic Eye Screening: Knowledge and Perspectives from Providers and Patients. Curr Diab Rep. 2017 Aug 31;17(10):94.