Updating Diabetic Retinopathy Screening Lists using Automatic Extraction from GP Patient Records

Scanlon, P H; Provins, EK; Craske, S; Chave, SJ; Aldington, S J; Martin, CN; Stratton, I M

doi:10.1177/0969141313505747

Cited by 2 publications

(4 citation statements)

References 7 publications

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“…9. We have previously shown (outside this project) that there are patients with diabetes unknown to screening programmes and that some of these have referable DR. 52 This project has shown that GP2DRS or similar software to extract demographic and risk factor data from primary care is necessary. 10.…”

Section: Resultsmentioning

confidence: 99%

“…A detailed investigation was carried out into the reasons why these patients were not known to Gloucestershire DESP. 52 2. Over the subsequent 12 months, we sent out patient information leaflets to practices in Gloucestershire, and we obtained risk factor data by September 2010 on 4220 people with diabetes by means of a single letter sent after screening at a practice asking that practice to provide a consent code update.…”

Section: Proposed Time Period For Retention Of Relevant Documentationmentioning

confidence: 99%

“…The GP2DRS project. 52 Gloucestershire was the Phase 1 pilot site for the GP2DRS project. This project is the primary phase of the GP2DRS programme, the objective of which is to automate the transfer of relevant patient information between GP practices and NHS DR screening programmes.…”

Section: Proposed Time Period For Retention Of Relevant Documentationmentioning

confidence: 99%

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Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Scanlon

Aldington

Leal

et al. 2015

Health Technol Assess

110

167

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BackgroundThe English NHS Diabetic Eye Screening Programme was established in 2003. Eligible people are invited annually for digital retinal photography screening. Those found to have potentially sight-threatening diabetic retinopathy (STDR) are referred to surveillance clinics or to Hospital Eye Services.ObjectivesTo determine whether personalised screening intervals are cost-effective.DesignRisk factors were identified in Gloucestershire, UK using survival modelling. A probabilistic decision hidden (unobserved) Markov model with a misgrading matrix was developed. This informed estimation of lifetime costs and quality-adjusted life-years (QALYs) in patients without STDR. Two personalised risk stratification models were employed: two screening episodes (SEs) (low, medium or high risk) or one SE with clinical information (low, medium–low, medium–high or high risk). The risk factor models were validated in other populations.SettingGloucestershire, Nottinghamshire, South London and East Anglia (all UK).ParticipantsPeople with diabetes in Gloucestershire with risk stratification model validation using data from Nottinghamshire, South London and East Anglia.Main outcome measuresPersonalised risk-based algorithm for screening interval; cost-effectiveness of different screening intervals.ResultsData were obtained in Gloucestershire from 12,790 people with diabetes with known risk factors to derive the risk estimation models, from 15,877 people to inform the uptake of screening and from 17,043 people to inform the health-care resource-usage costs. Two stratification models were developed: one using only results from previous screening events and one using previous screening and some commonly available GP data. Both models were capable of differentiating groups at low and high risk of development of STDR. The rate of progression to STDR was 5 per 1000 person-years (PYs) in the lowest decile of risk and 75 per 1000 PYs in the highest decile. In the absence of personalised risk stratification, the most cost-effective screening interval was to screen all patients every 3 years, with a 46% probability of this being cost-effective at a £30,000 per QALY threshold. Using either risk stratification models, screening patients at low risk every 5 years was the most cost-effective option, with a probability of 99-100% at a £30,000 per QALY threshold. For the medium-risk groups screening every 3 years had a probability of 43 –48% while screening high-risk groups every 2 years was cost-effective with a probability of 55–59%.ConclusionsThe study found that annual screening of all patients for STDR was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective. When personalised intervals are applied, screening those in our low-risk groups every 5 years was found to be cost-effective. Screening high-risk groups every 2 years further improved the cost-effectiveness of the programme. There was considerable uncertainty in the estimated incremental costs and in the incremental QALYs, particularly with regard to implications of an increasing proportion of maculopathy cases receiving intravitreal injection rather than laser treatment. Future work should focus on improving the understanding of risk, validating in further populations and investigating quality issues in imaging and assessment including the potential for automated image grading.Study registrationIntegrated Research Application System project number 118959.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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Section: Resultsmentioning

confidence: 99%

Section: Proposed Time Period For Retention Of Relevant Documentationmentioning

confidence: 99%

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Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Scanlon

Aldington

Leal

et al. 2015

Health Technol Assess

110

167

View full text Add to dashboard Cite

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“…98,99 Automated interrogation and extraction of electronic primary care data may identify additional candidates for screening. 100…”

Section: Changes To Dr Screening Service Deliverymentioning

confidence: 99%

<p>A Review of Advancements and Evidence Gaps in Diabetic Retinopathy Screening Models</p>

Pearce¹,

Sivaprasad²

2020

OPTH

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Diabetic retinopathy (DR) is a microvascular complication of diabetes with a prevalence of ~35%, and is one of the leading causes of visual impairment in people of working age in most developed countries. The earliest stage of DR, non-proliferative DR (NPDR), may progress to sight-threatening DR (STDR). Thus, early detection of DR and active regular screening of patients with diabetes are necessary for earlier intervention to prevent sight loss. While some countries offer systematic DR screening, most nations are reliant on opportunistic screening or do not offer any screening owing to limited healthcare resources and infrastructure. Currently, retinal imaging approaches for DR screening include those with and without mydriasis, imaging in single or multiple fields, and the use of conventional or ultra-wide-field imaging. Advances in telescreening and automated detection facilitate screening in previously hard-to-reach communities. Despite the heterogeneity in approaches to fit local needs, an evidence base must be created for each model to inform practice. In this review, we appraise different aspects of DR screening, including technological advances, identify evidence gaps, and propose several studies to improve DR screening globally, with a view to identifying patients with moderate-to-severe NPDR who would benefit if a convenient treatment option to delay progression to STDR became available.

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Updating Diabetic Retinopathy Screening Lists using Automatic Extraction from GP Patient Records

Cited by 2 publications

References 7 publications

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

<p>A Review of Advancements and Evidence Gaps in Diabetic Retinopathy Screening Models</p>

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