SAT-137 Improving Screening for Diabetic Retinopathy in a Resident Based Clinic

Introduction Diabetic retinopathy is the leading cause of blindness in US Adults. Early identification of retinopathy is crucial for preventing blindness because treatment becomes less effective as severity of the disease progresses. At our facility, a cross-sectional, retrospective study in 2017 showed that only 27% of eligible patients living with diabetes were up to date with retinopathy screening. We noted that patients who had already been diagnosed with diabetic retinopathy were significantly more likely to follow up with subsequent exams. We designed an intervention to improve screening rates and ultimately slow the progression of disease. Methods A quasi-experimental study of the effect of implementation of a non-mydriatic retinal camera was installed in our resident run clinic in April 2018. This camera was used to take images of patients’ retinas during their routine visits. The nursing staff received training on using the camera and ensuring image quality. A weekly workflow was implemented, consisting of generating a list of qualifying patients using our EMR (EPIC). The clinic staff offered a retinal photo to all patients on the weekly list at the time of rooming, before the resident saw the patient. These images were then sent to an ophthalmologist for review. Patients with an abnormal or poor quality retinal photo were subsequently contacted by their resident PCP and asked to follow with Ophthalmology. Results A total of 217 patients underwent retinal imaging at the resident based clinic from May to October 2018. Of the 217, 163 patients had gradable images (adequate quality to interpret). Of those, 43 out of 163 were found to have some degree of diabetic retinopathy (26%). Another 41 patients (25%) were diagnosed with ocular pathology of which they were previously unaware (including macular degeneration, glaucoma, and hypertensive retinopathy) and which had not been previously diagnosed. These patients were all then referred for formal ophthalmology evaluation and treatment. Data from the EPIC Diabetic Registry before and after the study period showed an improvement in overall screening rate from 20.5% in April 2018 to 62% in July 2018. Conclusion Implementation of a retinal camera and a staff led initiative to increase retinopathy screening was successful at increasing total number of patients screened for diabetic retinopathy compared to usual care provided by resident PCPs. Not only did the camera increase rate of screening, it also helped identify ophthalmologic pathology and expedite the time to intervention for these patients.