WELCH ALLYN RETINAVUE Care Delivery

Results in high rates of ophthalmic follow-up and treatment at Summit Medical Group.

INTRODUCTION

The best weapon against diabetic retinopathy is early detection, but compliance with diabetic retinal exams is low. Only about 60% of people with diabetes have recommended yearly screenings for diabetic retinopathy.¹ Yet, up to 95% of diabetes-related vision loss can be prevented if caught and treated early.²

Teleretinal imaging has been demonstrated to increase compliance rates for diabetic retinal exams with some clinics achieving compliance up to 90%.³ However, few studies have examined the long-term outcomes of patients receiving a teleretinal diabetic retinal exam.

STUDY OBJECTIVE

Summit Medical Group (SMG) is a large primary care organization spanning 13 different counties in eastern Tennessee with more than 300 providers in 66 offices. SMG implemented the RetinaVue care delivery model in 2015 to provide diabetic retinal exams to their patients at their annual office visit. A 2020 study by Stebbins, Kieltyka and Chaum analyzed the compliance of patients who were referred for specialist care based on their results from the diabetic retinal exam⁴:

1. Do patients referred for diabetic retinopathy (DR) from the RetinaVue care delivery model attend their follow-up appointments?

2. What is the accuracy of the referrals provided from the RetinaVue care delivery model?

STUDY METHODS

Since implementing the RetinaVue care delivery model in 2015, SMG has offered diabetic retinal eye exams to all their diabetic patients. SMG’s clinicians acquire the retinal images on both the right and left eye using the Welch Allyn RetinaVue 100 Imager during a patient's routine office visit. The clinician then transfers the fundus images through the Welch Allyn RetinaVue Network software to a team of board-certified ophthalmologists (RetinaVue, P.C.) who provide a diagnostic report and referral/care plan. Patients with referable DR are then recommended to follow up with an ey e care specialist, including those with:

• Mild non-proliferative diabetic retinopathy (NPDR) with clinically significant macular edema (CSME)
• Moderate NDPR with CSME
• Severe NPDR (any)
• Proliferative DR

To determine how many of these patients complied with this recommendation, SMG searched their records through the RetinaVue Network database (June 2015 through October 2017). From those patients, an additional search was conducted in the electronic medical record (EMR) database to identify:

• Patient demographics
• Ophthalmology notes and follow-up appointment attendance
• Prior history of DR
• Pathology identified
• Evidence of treatment received for DR

STUDY OUTCOMES: FOLLOW-UP COMPLIANCE

Based on the records from the EMR and the RetinaVue Network database, a total of 110 patients were identified with pathology for which referral was recommended. Of the 110 patients that SMG referred for follow-up care by ophthalmologists, 83 attended their appointment, a 75.5% compliance rate. Previous teleretinal imaging studies examining patient follow-up rates for up to two years have recorded compliance rates ranging from 32.8% to 60%.^5-9

Key takeaway: SMG experienced a 75.5% compliance rate for patients who were identified with pathology for which referral was recommended and attended follow-up appointments within one year of referral.

FOLLOW-UP TREATMENT RESULTS

The 83 patients who attended their follow-up appointment within one year were broken down  into the following eye conditions based on diagnosis upon follow-up:

• Referable DR: Proliferative DR (PDR), severe DR or CSME
• Non-Referable DR: Mild NPDR (Early DR with recommendation for another eye exam in 12 months)
• Non-Referable DR: Moderate NPDR (DR with recommendation to follow up with ophthalmologist within 6 months)
• Other retinal disease found or no diagnosis documented
• Unable to confirm DR

MISSED FOLLOW-UP

Of the 27 patients who did not attend a referral appointment within one year, 74.1% (20/27) had documented reasons for non-compliance:

• 33.3% followed up after one year
• 14.8% were deceased or left the practice
• 11.1% had an acute health issue impacting their ability to follow up

No reason was able to be determined for 25.9% (7/27) patients.

CONCLUSION

This study demonstrated that primary care based teleretinal imaging may result in higher compliance rates and accurate referrals for the eye care specialist.

Results show that 75.5% of SMG patients followed the recommended care plan — typically a referral to the eye specialist — within one year. Overall follow-up compliance increased to 83.6% when including patients who followed up after one year but within two years of their initial teleretinal imaging. Based on the results from the EMR, 89.2% of those patients were diagnosed with some level of DR upon follow-up assessment by the eye care specialist.

Increasing access to the diabetic retinal exam in primary care settings effectively identifies previously undetected eye disease, ensuring timely treatment to help preserve vision.

Of note, however, is an area for improvement in the U.S. healthcare system in general — the efficient sharing and documentation of patient data between disparate healthcare providers. While documentation of the diabetic eye exam in primary care settings is one of the benefits of teleretinal programs, primary care documentation of compliance with specialist referrals and treatments can still be a challenge as documented by the 25.9% of non-compliant patients with no follow-up and no documented reason for non-compliance. The primary care providers for the patients in this study contacted the specialist practices to obtain records missing from the primary care files. Better on-going communication and documentation between primary care providers and specialists will improve care planning and care delivery since primary care providers are ideally positioned to encourage compliance with follow-up appointments and treatment.