SCOPE: Diabetes Research Center

Here we seek to define a strategy to optimize the delivery of diabetic retinopathy screening (DRS) via telemedicine in primary care centers. This area of study is important because timely screening of diabetic retinopathy – the main cause of legal blindness in working-age Americans – may prevent vision loss, but is still significantly underused, especially in remote and underserved populations. With the advent of telemedicine, DRS became more accessible to patients in rural locations, as it allowed retina pictures to be taken in primary care clinics (PCCs) closer to the patient’s home, and later be interpreted by a remote eye care specialist. Recently, we have implemented one of the largest rural Telemedicine DRS (TDRS) networks in the country, providing DRS to multiple counties in Eastern Kentucky. This service proved valuable and desired by patients and healthcare professionals, but many centers showed a low or progressively decreasing yield in test numbers, due to factors such as decrease in awareness and motivation of the professionals involved, loss of familiarity with the technology, and absence of an optimal workflow. Here we use implementation science and quality improvement methods to build on our previous work and create strategies to optimize utilization of these cameras. To our knowledge, and despite the exponential interest in and use of TDRS, this is the first study to explore techniques to optimize access and delivery of DR screening via telemedicine. The strategy we develop in this project will be applicable to other TDRS networks worldwide, and may be used to optimize delivery of other screening tests performed in primary care settings. To achieve the stated goals, our project will address 2 areas: 1. Define and implement strategies to optimize TDRS uptake in PCCs; 2. Assess patient and personnel satisfaction with the new TDRS process.