Evaluating the cost and wait-times of a task-sharing model of care for diabetic eye care: a case study from Australia

Abstract

ObjectivesTo determine whether a collaborative model of care that uses task-sharing for the management of low-risk diabetic retinopathy, Community Eye Care (C-EYE-C), can improve access to care and better use resources, compared with hospital-based care.DesignRetrospective audit of medical and financial records to compare two models of care.SettingA large, urban tertiary Australian publicly funded hospital.InterventionC-EYE-C is a collaborative care model, involving community-based optometrist assessment and ‘virtual review’ by ophthalmologists to manage low-risk patients. The C-EYE-C model of care was implemented from January to October 2017.ParticipantsNew low-risk patient referrals with diabetes received at a tertiary hospital ophthalmology unit.Primary and secondary outcomesHistorical standard hospital care was compared with C-EYE-C for attendance, wait-times, outcomes and costs. Clinical concordance between the optometrist and ophthalmologist diagnosis and management was assessed using weighted kappa statistic.ResultsThere were 133 new low-risk referrals, managed in standard hospital care (n=68) and C-EYE-C (n=65). Attendance rates were similar between the models of care (72.1% hospital vs 67.7% C-EYE-C, p=0.71). C-EYE-C had shorter appointment wait-time (53 vs 118 days, p<0.01). In the C-EYE-C model of care, 68.2% of patients did not require hospital appointments and costs were 43% less than hospital care. There was substantial agreement between optometrists and ophthalmologists for diagnosis (κ=0.64, CI 0.47–0.81) and management (κ=0.66, CI 0.45–0.87).ConclusionThis Australian study showed that collaborative eye care resulted in reduced patient waiting times and considerable cost-savings, while maintaining a high standard of patient care compared with traditional hospital-based care in the management of low-risk hospital referrals with diabetic eye disease. The improved access and reduced costs were largely the result of better task allocation through greater utilisation of primary eye care professionals to provide services for low-risk patients. Better resource use may free up further resources for other eye care services.

Benefits of Integrating Telemedicine and Artificial Intelligence Into Outreach Eye Care: Stepwise Approach and Future Directions

“…For eye care in Australia, optometrists represent an accessible, publicly funded, and well-equipped resource to help tackle population eye health needs. Collaborative care models involving community-based optometrists and virtual review by an ophthalmologist using “store-and-forward” telemedicine modalities have been demonstrated for glaucoma and diabetes clinics in Australia, leading to cost-savings and reduced wait times ( 21 , 22 ). Exploring options for upscaling these models has the potential to further improve the capacity of public eye services.…”

Experiences of Patients With Diabetes Attending a Publicly Funded Eye Care Pathway in Western Sydney: A Qualitative Study

“…Based on these accounts, strategies that seek to shorten wait times and choices in this setting will likely improve the patient experience. Collaborative care schemes are one approach which has been shown to significantly shorten hospital wait times for patients with low risk or stable DR (18). Such schemes might also offer a better patient experience by delivering care in more acceptable locations, with greater access to transport or reduced travel times (27).…”

“…A community-based optometry clinic delivering a collaborative model of care for low-grade DR through Medicare, with no out-of-pocket costs (18).…”

“…This study was conducted at several public-funded eye care services in the region where patients with DR were receiving free care under the guidance of an ophthalmologist. The services included: One tertiary public hospital ophthalmology department. Two clinics providing services to hospital patients under a service agreement: A community-based optometry clinic delivering a collaborative model of care for low-grade DR through Medicare, with no out-of-pocket costs (18). An ophthalmology practice delivering DR treatments (ie, anti-VEGF injections and laser treatment) through Medicare, with no out-of-pocket costs. …”

“…Two clinics providing services to hospital patients under a service agreement: A community-based optometry clinic delivering a collaborative model of care for low-grade DR through Medicare, with no out-of-pocket costs (18). An ophthalmology practice delivering DR treatments (ie, anti-VEGF injections and laser treatment) through Medicare, with no out-of-pocket costs. …”