Improving Diabetic Retinopathy Screening Among Patients With Diabetes Mellitus Using the Define, Measure, Analyze, Improve, and Control Process Improvement Methodology

Cataract and diabetic retinopathy are leading causes of blindness globally. Lifeline Express (LEX) has pioneered the provision of cataract surgery in rural China from custom-built trains and eye centres nationwide. Over the past two decades, LEX has provided free cataract surgery for over 180 000 patients in China. In China, half of the adult population has prediabetes and 113 million adults have diabetes. Recognising the rising threat of diabetic retinopathy, LEX has expanded to providing free diabetic retinopathy screening nationwide by establishing 29 Diabetic Retinopathy Screening Centres across China. Source of referrals included host hospitals, the community and out-reach mobile vans equipped with fundus cameras. Fundi photos taken in the mobile vans were electronically transferred to primary graders. LEX also leveraged the widespread smartphone use to provide electronic medical reports via WeChat, the most popular instant messenger app in China. From April 2014 to December 2016, 34 506 patients with diabetes underwent screening, of which 27.2% (9,396) were identified to have diabetic retinopathy. China’s latest national health strategy (‘Healthy China 2030 Plan’) has championed the ‘prevention first’ principle and early screening of chronic diseases. LEX has accordingly evolved to extend its services to save sight in China—from cataract surgery to diabetic retinopathy screening and most recently outreaching beyond its national borders in a pilot South–South collaboration. With health at the top of the China’s developmental agenda and the country’s growing role in global health—LEX’s large-scale telemedicine-enabled programme could represent a potentially scalable model for nationwide diabetic retinopathy screening elsewhere.

Download Full-text

Incidence of diabetic retinopathy in people with type 2 diabetes mellitus attending the Diabetic Retinopathy Screening Service for Wales: retrospective analysis

BMJ ◽

10.1136/bmj.e874 ◽

2012 ◽

Vol 344 (feb22 1) ◽

pp. e874-e874 ◽

Cited By ~ 77

Author(s):

R. L. Thomas ◽

F. Dunstan ◽

S. D. Luzio ◽

S. Roy Chowdury ◽

S. L. Hale ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Retrospective Analysis ◽

Screening Service ◽

Diabetic Retinopathy Screening ◽

Retinopathy Screening

Download Full-text

Incidence of diabetic retinopathy in people with type 2 diabetes mellitus attending the Diabetic Retinopathy Screening Service for Wales: retrospective analysis

BMJ ◽

10.1136/bmj.e1524 ◽

2012 ◽

Vol 344 (feb28 3) ◽

pp. e1524-e1524

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Retrospective Analysis ◽

Screening Service ◽

Diabetic Retinopathy Screening ◽

Retinopathy Screening

Download Full-text

Adherence to ophthalmology referral, treatment and follow-up after diabetic retinopathy screening in the primary care setting

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-001154 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001154

Author(s):

George Bresnick ◽

Jorge A Cuadros ◽

Mahbuba Khan ◽

Sybille Fleischmann ◽

Gregory Wolff ◽

...

Keyword(s):

Primary Care ◽

Diabetic Retinopathy ◽

Complete Information ◽

Persistent Problem ◽

Diabetic Retinopathy Screening ◽

Patients With Diabetes ◽

The Usa ◽

Adherence Monitoring ◽

Retinopathy Screening

IntroductionTelemedicine-based diabetic retinopathy screening (DRS) in primary care settings has increased the screening rates of patients with diabetes. However, blindness from vision-threatening diabetic retinopathy (VTDR) is a persistent problem. This study examined the extent of patients’ adherence to postscreening recommendations.Research design/methodsA retrospective record review was conducted in primary care clinics of a large county hospital in the USA. All patients with diabetes detected with VTDR in two time periods, differing in record type used, were included in the study: 2012–2014, paper charts only; 2015–2017, combined paper charts/electronic medical records (EMRs), or EMRs only. Adherence rates for keeping initial ophthalmology appointments, starting recommended treatments, and keeping follow-up appointments were determined.ResultsAdequate records were available for 6046 patients; 408 (7%) were detected with VTDR and recommended for referral to ophthalmology. Only 5% completed a first ophthalmology appointment within recommended referral interval, 15% within twice the recommended interval, and 51% within 1 year of DRS. Patients screened in 2015–2017 were more likely to complete a first ophthalmology appointment than those in 2012–2014. Ophthalmic treatment was recommended in half of the patients, of whom 94% initiated treatment. A smaller percentage (41%) adhered completely to post-treatment follow-up. Overall, 28% of referred patients: (1) kept a first ophthalmology appointment; (2) were recommended for treatment; and (3) initiated the treatment. Most patients failing to keep first ophthalmology appointments continued non-ophthalmic medical care at the institution. EMRs provided more complete information than paper charts.ConclusionsReducing vision impairment from VTDR requires greater emphasis on timely adherence to ophthalmology referral and follow-up. Prevention of visual loss from VTDR starts with retinopathy screening, but must include patient engagement, adherence monitoring, and streamlining ophthalmic referral and management. Revision of these processes has already been implemented at the study site, incorporating lessons from this investigation.

Download Full-text

Factors associated with non-attendance in the Irish national diabetic retinopathy screening programme (INDEAR study report no. 2)

Acta Diabetologica ◽

10.1007/s00592-021-01671-4 ◽

2021 ◽

Author(s):

Stephen R. Kelly ◽

Allison R. Loiselle ◽

Rajiv Pandey ◽

Andrew Combes ◽

Colette Murphy ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Screening Programme ◽

Intervention Strategy ◽

Cost Effective ◽

Missed Appointments ◽

Diabetic Retinopathy Screening ◽

Patients With Diabetes ◽

Retinopathy Screening

Abstract Aims We aimed to determine the patient and screening-level factors that are associated with non-attendance in the Irish National Diabetic Retinal screening programme (Diabetic RetinaScreen). To accomplish this, we modelled a selection of predictors derived from the historical screening records of patients with diabetes. Methods In this cohort study, appointment data from the national diabetic retinopathy screening programme (RetinaScreen) were extracted and augmented using publicly available meteorological and geospatial data. A total of 653,969 appointments from 158,655 patients were included for analysis. Mixed-effects models (univariable and multivariable) were used to estimate the influence of several variables on non-attendance to screening appointments. Results All variables considered for analysis were statistically significant. Variables of note, with meaningful effect, were age (OR: 1.23 per decade away from 70; 95% CI: [1.22–1.24]), type 2 diabetes (OR: 1.10; 95% CI: [1.06–1.14]) and socio-economic deprivation (OR: 1.12; 95% CI: [1.09–1.16]). A majority (52%) of missed appointments were from patients who had missed three or more appointments. Conclusions This study is the first to outline factors that are associated with non-attendance within the Irish national diabetic retinopathy screening service. In particular, when corrected for age and other factors, patients with type 2 diabetes had higher rates of non-attendance. Additionally, this is the first study of any diabetic screening programme to demonstrate that weather may influence attendance. This research provides unique insight to guide the implementation of an optimal and cost-effective intervention strategy to improve attendance.

Download Full-text