OBJECTIVE -To evaluate the impact of a telemedicine, digital retinal imaging strategy on diabetic retinopathy screening rates in an inner-city primary care clinic. RESULTS -Retinal screening was documented for 293 (59.2%) patients, a significant improvement compared with the 23% baseline rate. Of 293 patients screened, 92 (31.4%) were screened in ophthalmology, and 201 (68.6%) were digitally screened. Among the 201 digitally screened patients, 104 (51.7%) screened negative and were advised to rescreen in 1 year, 75 (37.3%) screened positive and were nonurgently referred to ophthalmology, and 22 (11.0%) screened positive for sight-threatening eye disease and were urgently referred for ophthalmological follow-up. Digital imaging technical failure rate was 0.5%. Referral status was associated with race/ethnicity ( 2 ϭ 7.9, P Ͻ 0.02) with whites more likely to screen negative than non-whites (62.4 vs. 47.8%, respectively). Sight-threatening disease among non-whites (14.7%) was more than double that observed for whites (5.9%). RESEARCH DESIGN AND METHODSCONCLUSIONS -Digital imaging technology in the primary care visit can significantly improve screening rates over conventional methods, increase access to recommended diabetic eye care, and focus specialty care on medically indigent patients with greatest need. Diabetes Care 30:574 -578, 2007D iabetic retinopathy (DR) is a leading cause of adult blindness in the U.S. despite the availability of treatments that postpone or prevent most diabetes-related vision loss (1,2). The Centers for Disease Control and Prevention (1) report that 21 million Americans have diabetes, which is a 14% increase in prevalence from 2003 to 2005, and estimates link as many as 24,000 new cases of blindness to DR per year. Increases in DRrelated disabilities are anticipated due to population aging and the rapid increase in prevalence of diabetes. Future forecasts are not encouraging, as 41 million Americans have pre-diabetes, and 1 of 3 Americans born in the year 2000 are expected to be diagnosed with diabetes during their lifetime. The increasing incidence of diabetes is expected to be even greater among minority subgroups (e.g., one of two Hispanic Americans born in 2000) with concurrent increases in comorbid conditions such as DR. Increasing prevalence of type 2 diabetes among younger age groups may exacerbate these predictions (3).DR denotes a spectrum of microvascular changes associated with hyperglycemia. It is typically asymptomatic before the onset of vision loss but is detectable with the standard annual dilated retinal examination and visual acuity assessment recommended by the American Diabetes Association (4). Yet, using the traditional approach to detecting diabetic eye disease, which involves referral to an ophthalmologist by the patient's primary care provider, only about half of all diabetic patients in the U.S. receive the recommended annual screening for DR and, by extension, access to effective treatment (5,6). Racial/ethnic minorities and other groups with limited access to ...

Background: Diabetes care in our inner-city primary care clinic was suboptimal, despite provider education and performance feedback targeting improved adherence to evidence-based clinical guidelines. A crew resource management (CRM) intervention (communication and teamwork, process and workflow organisation, and standardised information debriefings) was implemented to improve diabetes care and patient outcomes. Objective: To assess the effect of the CRM intervention on adherence to evidence-based diabetes care standards, work processes, standardised clinical communication and patient outcomes. Methods: Time-series analysis was used to assess the effect on the delivery of standard diabetes services and patient outcomes among medically indigent adults (n = 619). Results: The CRM principles were translated into useful process redesign and standardised care approaches. Significant improvements in microalbumin testing and associated patient outcome measures were attributed to the intervention. Conclusions: The CRM approach provided tools for management that, in the short term, enabled reorganisation and prevention of service omissions and, in the long term, can produce change in the organisational culture for continuous improvement.

Cluster analysis is an effective alternative for grouping individuals for use in public health education, intervention, and outreach programming. Women receiving no prenatal care were characteristically different from women receiving any care in this study, but they did not represent a homogenous group. Findings suggest that interventions should target reducing the proportion of women receiving no care and should be tailored to specific no-care clusters.

This project to define basic nursing care activities and incorporate into the electronic health record represents a first step in capturing meaningful data elements. When fully implemented, these data could be translated into knowledge for improving care outcomes and collaborative processes.

The objective of this study is to report the findings of a 7-month pilot for an integrated system evaluating a state-wide home visiting program. A cross-sectional study design was used to determine baseline process and outcome measures for Tennessee's home visiting program which provides services to families, from pregnancy through 5-years-old. Baseline process measures included: time to initiate service after referral; frequency, duration and intensity of visits; completion of continuous assessment; and time from identification of a need to referral. The baseline outcome measures included: needs of eligible services (e.g. developmental screenings, WIC); prenatal care utilization; biological risks (prematurity; low birth weight); tobacco use and second-hand smoke exposure; and family planning utilization. During the pilot, 3,794 families were enrolled, representing 68% (± 1.5%) of incoming referrals. Enrollment dropped from 82% (90 days) to 69% (120 days); 52% of the families received a visit every month. Ninety percent of families had at least one full assessment after enrollment; 60% occurred within the first 60 days. Over 92% of outgoing referrals were made within 7 days. Immunization status (70%) is below the state level (80.8%). A quarter of the infants enrolled in the program are low birth weight and premature (state level 9.2%). Current tobacco use by the prenatal population is 16% compared to the state, 19.7%. The HUGS program serves high risk/high need clients and is consistent with other national home visiting models that have shown higher levels of attrition and lower levels of visits than intended by the model.