An Initiative to Improve Follow-up of Patients with Glaucoma

Abstract

Purpose: This study describes the implementation of an electronic medical record (EMR)-based initiative aimed at reducing the number of patients with glaucoma-related diagnoses lost to follow-up (LTF) and reviews its short-term outcomes.Design: Retrospective, comparative case series.Participants: Patients with glaucoma-related diagnoses seen 1 year prior at the Lahey Medical Center and who had not returned within the 6-month period between January 1, 2020, and June 30, 2020, which spanned the outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic in the United States.Methods: An EMR-based tool was designed to identify patients suspected of being LTF with glaucomarelated diagnoses. Providers were enlisted to review the EMR for each of these patients and re-engage them, as appropriate. One month later, the initiative was evaluated by means of a retrospective chart review. Binary logistic regression analysis was used to identify demographic, clinical, and sociomedical factors associated with being LTF.Main Outcome Measures: Patients who completed a telemedicine or in-person appointment, or had a future scheduled or ordered return appointment, were considered re-engaged.Results: Of the 3551 patients seen during the study period, 384 patients were identified as LTF (11%), with 60 identifying COVID-19 as the reason for canceling their visit (16%). Patients who lived farther from the eye clinic (P < 0.001) or who had a history of canceling or missing an appointment (P < 0.001) were more likely to be LTF. Patients with open-angle glaucoma (P ¼ 0.042) or who had completed a visual field (P < 0.001) or ophthalmic imaging (P < 0.001) within the past year were less likely to be LTF. One month after the re-engagement initiative, 124 LTF patients (32%) had been re-engaged (40% through telemedicine), 238 patients (62%) had future scheduling orders in place, and 22 patients (6%) had no active plan for future follow-up.Conclusions: An EMR-based tool is an effective method for identifying patients at risk of being LTF and provides an opportunity for providers to recall and re-engage patients. Use of telemedicine to recontact LTF patients shows promise of improving the management of glaucoma, enhancing clinical productivity, and documenting treatment plans, thereby potentially reducing medicolegal liability. Ophthalmology

An initiative to improve follow‐up of patients with diabetic retinopathy

“…14 LTF rates reported among patients with glaucoma have ranged from 1.3% 46%. 12,15,16 In just 1 month after the initiation of our provider-based re-engagement initiative, more than one-quarter of DR patients identified as LTF were re-engaged, and the majority of the remaining patients were accounted for with providerordered recall or scheduled appointments. We found that younger patients and those with poor metabolic control were prone to gaps in care.…”

“…This period was selected in part because it coincided with the outbreak of the COVID-19 pandemic in the United States, which caused many patients to miss or delay eye care. 8,12 Deceased patients and those with future-scheduled appointments were excluded. Patient demographics (age, gender, race/ethnicity and primary language spoken), and most recent clinical characteristics (blood pressure [BP], body mass index [BMI], haemoglobin A1c [HbA1c], low-density lipoprotein level [LDL], microalbumin and retinopathy stage), and ophthalmology appointment data (completed, cancelled and no-show appointments in the preceding year), along with history of optical coherence tomography [OCT] retinal imaging, were extracted from the EMR for each patient by means of a custom reporting tool.…”

“…Patient demographics (age, gender, race/ethnicity and primary language spoken), and most recent clinical characteristics (blood pressure [BP], body mass index [BMI], haemoglobin A1c [HbA1c], low-density lipoprotein level [LDL], microalbumin and retinopathy stage), and ophthalmology appointment data (completed, cancelled and no-show appointments in the preceding year), along with history of optical coherence tomography [OCT] retinal imaging, were extracted from the EMR for each patient by means of a custom reporting tool. 12 Providers each received a list of their patients with DR who were potentially LTF, along with a request to reengage them, as appropriate. Since the definition of being potentially LTF was going 6 months without being seen, providers were made aware that some of the patients identified in the report might not actually be overdue for care.…”

“…Electronic medical record (EMR) systems are an important but underutilised tool available to improve the delivery of care to patients with DR and other eye conditions. 12 The purpose of this study is to evaluate an EMR-based initiative intended to help providers identify and re-engage patients with DR who are lost to follow-up (LTF). We identify factors that are predictive of LTF, as well as which of these patients are more likely to be re-engaged by their providers.…”

Telehealth Encourages Patients with Diabetes in Racial and Ethnic Minority Groups to Return for in-Person Ophthalmic Care During the COVID-19 Pandemic

“…We extracted from the electronic medical record patient demographics (age, gender, race/ethnicity, and primary language spoken), clinical characteristics (visual acuity, type of DM, severity of DR, and hemoglobin A1c[%]) and ophthalmology appointment data for each patient by means of a customized reporting tool. 24 Type of DM and DR was defined by ICD-10-CM codes and stage of DR based on the more severely affected eye: mild non-proliferative diabetic retinopathy (NPDR; E10.32/E11.32), moderate NPDR (E10.33/E11.33), severe NPDR (E10.34/E11.34), and proliferative diabetic retinopathy (PDR; E10.35/E11.35). Distance to the nearest eye clinic was computed by using an Excel VBA program to access Microsoft Maps which calculated the distance between each patient's home zip code and the clinic zip code.…”