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 ...

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A multicomponent intervention was attempted in a pediatric emergency department to increase reporting of workplace aggression committed by patients and visitors. Overall reporting decreased from 53% to 47% (P = .06). Reasons for reporting were severity of incident and being asked to report. Reasons for not reporting were incidents being too minor and no action would be taken. Future change efforts need to consider multiple modes of communication to promote adoption of reporting and inclusion of administrators in efforts to improve reporting.