Effect of a Teleretinal Screening Program on Eye Care Use and Resources

Abstract

he Veterans Health Administration is the largest integrated health care system in the United States. It serves more than 5.5 million veterans, including more than 97 million outpatient visits. 1 To improve access to health care for veterans, a diabetic teleretinal screening program was established in 2006 to screen veterans for diabetic retinopathy within community-based primary care clinics. Retinal cameras are used to capture images, which are remotely interpreted by an eye care professional in a centralized reading center. Patients with findings suggestive of ocular disease are referred for an ophthalmic evaluation in the eye clinic. The diabetic teleretinal screening program has improved the provision of preven-tive screening care to veterans, with approximately 90% of patients with diabetes mellitus evaluated on a regular basis nationally. 1 The ophthalmic care of patients who are referred by a diabetic screening program uses resources at medical centers that include clinic appointments, diagnostic procedures, spectacles, medications, vision rehabilitation, and surgery. Consequently, the establishment of a teleretinal imaging service significantly increases specialty workload in the affiliated eye clinic because, without this service, many veterans might forgo ophthalmic care. To our knowledge, the effect of additional referrals on medical center resources has not been IMPORTANCE Telemedicine is a useful clinical method to extend health care to patients with limited access. Minimal information exists on the subsequent effect of telemedicine activities on eye care resources. OBJECTIVE To evaluate the effect of a community-based diabetic teleretinal screening program on eye care use and resources. DESIGN, SETTING, AND PARTICIPANTS The current study was a retrospective medical record review of patients who underwent diabetic teleretinal screening in the community-based clinics of the Atlanta Veterans Affairs Medical Center from October 1, 2008, through March 31, 2009, and who were referred for an ophthalmic examination in the eye clinic.EXPOSURES Clinical medical records were reviewed for a 2-year period after patients were referred from teleretinal screening. The following information was collected for analysis: patient demographics, referral and confirmatory diagnoses, ophthalmology clinic visits, diagnostic procedures, surgical procedures, medications, and spectacle prescriptions. MAIN OUTCOMES AND MEASURESThe accuracy between referring and final diagnoses and the eye care resources that were used in the care of referred patients. RESULTSThe most common referral diagnoses were nonmacular diabetic retinopathy (43.2%), nerve-related disease (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%), and diabetic macular edema (5.6%). The percentage of agreement among these 5 visually significant diagnoses was 90.4%, with a total sensitivity of 73.6%. Diabetic macular edema required the greatest number of ophthalmology clinic visits, diagnostic tests, and surgical procedures. Using Medicar...

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