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Automated Reminders Improve Retinal Screening Rates in Low Income, Minority Patients with Diabetes and Correct the African American Disparity

  • Systems-Level Quality Improvement
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Abstract

Diabetic retinopathy (DR) is a major cause of blindness in the United States. Prevention relies on periodic DR screening, yet overall national screening rates are not optimal, especially in low-income, minority patients. We prospectively evaluated show rates for prescheduled teleretinal DR screening appointments in diabetic patients (n = 301) in a large safety-net clinic in South Central Los Angeles. Patients were predominately African American (n = 88) and Latino (n = 200). Patients received either usual care telephone reminders or automated reminder calls in addition to usual care. The overall mean (SEM) show rate for DR screening, irrespective of reminder method, was low: 54 + 1.03%. Show rates with usual care alone were 46.3 + 2.6%, and with automated reminders added, 59.9 + 1.47% (p = 0.036). Show rate with usual care amongst African Americans was 23.6 + 6.46% compared with 53.2 + 3.41% for Latinos (p = 0.025). When automated calling was added, the show rate doubled amongst African Americans, to 51.6 + 3.96% (p = 0.002) with a slightly higher, non-significant show rate in Latinos. In summary, show rates for pre-scheduled teleretinal DR screening appointments were low with usual care alone in a safety-net clinic, with evidence for a racial disparity amongst low–income, minority patients with diabetes. Addition of a pre-recorded automated reminder call improved show rates, and corrected much of the racial disparity observed. Greater focus on failed appointments as an explanation for low DR screening rates and racial disparities, and as a potentially remediable target with automated reminders, may improve DR screening rates and reduce blindness in low-income minority patients with diabetes.

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References

  1. Center for Disease Control and Prevention (2017) Blindness and vision impairment. https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/Blindness.html. Accessed 01 July 2018

  2. The Diabetes Control and Complications Trial Research Group, The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 329:977–986, 1993.

    Article  Google Scholar 

  3. King, P., Peacock, I., and Donnelly, R., The UK prospective diabetes study (UKPDS): Clinical and therapeutic implications for type 2 diabetes. Br. J. Clin. Pharmacol. 48(5):643–648, 1999.

    Article  CAS  Google Scholar 

  4. Daskivich, L. P., Vasquez, C., Martinez, C., Tseng, C.-H., and Mangione, C. M., Implementation and evaluation of a large-scale teleretinal diabetic retinopathy screening program in the Los Angeles County Department of Health Services. JAMA Intern. Med. 177(5):642–649, 2017.

    Article  Google Scholar 

  5. American Academy of Ophthalmology Retina/Vitreous Panel, Preferred practice pattern guidelines. Diabetic retinopathy. San Francisco (CA): American Academy of Ophthalmology, 2017.

  6. Casagrande, S. S., Fradkin, J. E., Saydah, S. H., Rust, K. F., and Cowie, C. C., The prevalence of meeting A1c, blood pressure, and LDL goals among people with diabetes, 1988-2010. Diabetes Care 36:2271–2279, 2013.

    Article  CAS  Google Scholar 

  7. Forster, A. S., Forbes, A., Dodhia, H., Connor, C., du Chemin, A., Sivaprasad, S., Mann, S., and Gulliford, M. C., Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: A population-based cohort study. Diabetologia 56(10):2187–2193, 2013.

    Article  Google Scholar 

  8. Lanting, L. C., Joung, I. M. A., Mackenback, J. P., Lamberts, S. W. J., and Bootsma, A., Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients. Diabetes Care 28(9):2280–2288, 2005.

    Article  Google Scholar 

  9. Kuo, J. Z., Guo, X., Klein, R., Klein, B. E., Weinreb, R. N., Genter, P., Hsiao, F. C., Goodarzi, M. O., Rotter, J. I., Chen, Y. D., and Ipp, E., Association of fasting insulin and C peptide with diabetic retinopathy in Latinos with type 2 diabetes. BMJ Open Diabetes Res. Care 2(1):e000027, 2014. https://doi.org/10.1136/bmjdrc-2014-000027.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lu, Y., Serpas, L., Genter, P., Anderson, B., Campa, D., and Ipp, E., Divergent perceptions of barriers to diabetic retinopathy screening among patients and care providers, Los Angeles, California, 2014-2015. Prev. Chronic Dis. 13:E140, 2016. https://doi.org/10.5888/pcd13.160193.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shi, Q., Zhao, Y., Fonseca, V., Krousel-Wood, M., and Shi, L., Racial disparity of eye examination among the U.S. working-age population with diabetes: 2002-2009. Diabetes Care 37:1321–1328, 2014.

    Article  Google Scholar 

  12. Lu, Y., Serpas, L., Genter, P., Mehranbod, C., Campa, D., and Ipp, E., Disparities in diabetic retinopathy screening rates within minority populations: Differences in reported screening rates among African American and Hispanic patients. Diabetes Care 39(3):e31–e32, 2016. https://doi.org/10.2337/dc15-2198.

    Article  PubMed  Google Scholar 

  13. Paksin-Hall, A., Dent, M. L., Dong, F., and Ablah, E., Factors contributing to diabetes patients not receiving annual dilated eye examinations. Ophthalmic Epidemiol. 20(5):281–287, 2013.

    Article  Google Scholar 

  14. Murchison, A. P., Hark, L., Pizzi, L. T. et al., Non-adherence to eye care in people with diabetes. BMJ Open Diabetes Res. Care 5(1):e000333, 2017. https://doi.org/10.1136/bmjdrc-2016-000333.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hasvold, P. E., and Wootton, R., Use of telephone and SMS reminders to improve attendance at hospital appointments: A systematic review. J. Telemed. Telecare 17:358–364, 2011.

    Article  Google Scholar 

  16. Geraghty, M., Glynn, F., Amin, M., and Kinsella, J., Patient mobile telephone ‘text’ reminder: A novel way to reduce non-attendance at the ENT out-patient clinic. J. Laryngol. Otol. 122:296–298, 2008.

    Article  CAS  Google Scholar 

  17. McLean, S., Gee, M., Booth, A., et al., Targeting the use of reminders and notifications for uptake by populations (TURNUP): A systematic review and evidence synthesis. Health Serv Deliv Res No. 2.34, (2014)

  18. Almong, D. M., Devries, J. A., Borrelli, J. A., and Kopycha-Kedzierawski, D. T., The reduction of broken appointment rates through an automated appointment confirmation system. J. Dent. Educ. 67(9):1016–1022, 2003.

    Google Scholar 

  19. Koshy, E., Car, J., and Majeed, A., Effectiveness of mobile-phone short message service (SMS) reminders for ophthalmology outpatient appointments: Observational study. BMC Ophthalmol. 8:9, 2008. https://doi.org/10.1186/1471-2415-8-9.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Callinan, C. E., Kenney, B., Hark, L. A., Murchison, A. P., Dai, Y., Leiby, B. E., Mayro, E. L., Bilson, J., and Haller, J. A., Improving follow-up adherence in a primary eye care setting. Am. J. Med. Qual. 32(1):73–79, 2017.

    Article  Google Scholar 

  21. NCQA HEDIS measures for diabetic eye exams (2017). http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2017-table-of-contents/diabetes-care. Accessed 01 July 2018

  22. Lee, C. S., Lee, A. Y., Baughman, D., Sim, D., Akelere, T., Brand, C., Crabb, D. P., Denniston, A. K., Downey, L., Fitt, A., Khan, R., Mahmood, S., Mandal, K., Mckibbin, M., Menon, G., Lobo, A., Kumar, B. V., Natha, S., Varma, A., Wilkinson, E., Mitry, D., Bailey, C., Chakravarthy, U., Tufail, A., Egan, C., and UK DR EMR Users Group, The United Kingdom diabetic retinopathy electronic medical record users group: Report 3: Baseline retinopathy and clinical features predict progression of diabetic retinopathy. Am. J. Ophthalmol. 180:64–71, 2017.

    Article  Google Scholar 

  23. Schmier, J. K., Covert, D. W., Matthews, G. P., and Zakov, Z. N., Impact of visual impairment on service and device use by individuals with diabetic retinopathy. Disabil. Rehabil. 31(8):659–665, 2009.

    Article  Google Scholar 

  24. Jani, P. D., Forbes, L., Choudhury, A., Preisser, J. S., Viera, A. J., and Garg, S., Evaluation of diabetic retinal screening and factors for ophthalmology referral in a telemedicine network. JAMA Ophthalmol. 135(7):706–714, 2017.

    Article  Google Scholar 

  25. Tsan, G. L., Hoban, K. L., Jun, W., Riedel, K., Pedersen, A. L., and Hayes, J., Assessment of diabetic teleretinal imaging program at the Portland Department of Veterans Affairs Medical Center. JRRD 52(2):193–200, 2015.

    Article  Google Scholar 

  26. Conlin, P. R., Fisch, B. M., Cavallerano, A. A., Cavallerano, J. D., Bursell, S.-E., and Aiello, L. M., Nonmydriatic teleretinal imaging improves adherence to annual eye examinations in patients with diabetes. J. Rehabil. Res. Dev. 43(6):733–740, 2006.

    Article  Google Scholar 

  27. Scalon, P. H., The English National Screening Programme for diabetic retinopathy 2003-2016. Acta. Diabetol. 53:515–525, 2017.

    Article  Google Scholar 

  28. Anderson, N., Hjortdal, J. O., Schielke, K. C. et al., The Danish registry of diabetic retinopathy. Clinical Epidemiol. 8:613–619, 2016.

    Article  Google Scholar 

  29. Van Ejik, K. N. D., Blom, J. W., Gussekloo, J., Polak, B. C. P., and Groeneveld, Y., Diabetic retinopathy screening in patients with diabetes mellitus in primary care: Incentives and barriers to screening attendance. Diabetes Res. Clin. Pract. 96(1):10–16, 2012.

    Article  Google Scholar 

  30. Looker, H. C., Nyangoma, S. O., Cromie, D. T. et al., Rates of referable eye disease in the Scottish National Diabetic Retinopathy Screening Programme. Br. J. Ophthalmol. 98:790–795, 2014.

    Article  CAS  Google Scholar 

  31. Kashim, R. M., Newton, P., and Ojo, O., Diabetic retinopathy screening: A systematic review on patient’s non-attendance. Int. J. Environ. Res. Public Health 15(1):157, 2018. https://doi.org/10.3390/ijerph15010157.

    Article  PubMed Central  Google Scholar 

  32. Fathy, C., Patel, S., Sternberg, P., and Kohanim, S., Disparities in adherence to screening guidelines for diabetic retinopathy in the United States: A comprehensive review and guide for future directions. Semin. Ophthalmol. 31(4):364–377, 2016.

    Article  Google Scholar 

  33. Waqar, S., Bullen, G., Chant, S., Salman, R., Vaidya, B., and Ling, R., Cost implications, deprivation and geodemographic segmentation analysis of non-attenders (DNA) in an established diabetic retinopathy screening programme. Diab. Metab. Syndr. 6:199–202, 2012.

    Article  Google Scholar 

  34. Moore, C. G., Wilson-Witherspoon, P., and Probst, J. C., Time and money: Effects of no-shows at a family practice residency clinic. Fam. Med. 33(7):522–527, 2001.

    CAS  PubMed  Google Scholar 

  35. Hamilton, W., Luthra, M., Smith, T., and Evans, P., Non-attendance in general practice: a questionnaire survey. Prim. Health Care Res. Dev. 3:226–230, 2002.

    Article  Google Scholar 

  36. Murdock, A., Rodgers, C., Lindsay, H., and Tham, T. C. K., Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. J. R. Soc. Med. 95(6):284–286, 2002.

    Article  CAS  Google Scholar 

  37. Ipp, E., Shah, V. N., Bode, B. W., Sadda, S. R., 599-P: diabetic retinopathy (DR) screening performance of general ophthalmologists, retina specialists, and artificial intelligence (AI): analysis from a pivotal multicenter prospective clinical trial. Diabetes 68(Supplement 1):599-P, 2019.

    Article  Google Scholar 

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Acknowledgements

We thank the patients and staff who participated in this study. C.M., P.G., L.S., and J.M. contributed to the study concept and design, data acquisition, and revision of the article for important intellectual content. D.C. and D.B. contributed to study concept and revision of the article for important intellectual content. E.I. supervised the study and contributed to the study concept and design; data acquisition, analysis, and interpretation; and revision of the article for important intellectual content. E.I. is the guarantor of this study and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors would like to give a special thanks to Juan Ortega and Milan Adaea Zavolta for their invaluable assistance with this project. Part of this study was presented at the Endocrine Society’s 100th Annual Meeting and Expo, Chicago, IL, March 17-20, 2018.

Funding

This study was funded by the California Community Foundation (principal investigator, EI, CMCH-14- 111,663) and the Genentech Foundation. Neither foundation participated in the study design; in the collection, analysis, and interpretation of data; in the writing of the article; or in the decision to submit the article for publication. Partial funding was also provided by the National Center for Advancing Translational Sciences (CTSI grant UL1TR000124).

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Authors and Affiliations

  1. Harbor-UCLA Medical Center and Lundquist Research Institute, 1124 West Carson St, Torrance, CA, 90502, USA

    Christina Mehranbod, Pauline Genter, Lilian Serpas, Johana Macias & Eli Ipp

  2. Los Angeles County Department of Health Services, Los Angeles, CA, USA

    David Campa, David Bermon & Eli Ipp

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  1. Christina Mehranbod
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Correspondence to Eli Ipp.

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EI is also affiliated with the David Geffen School of Medicine at University of California, Los Angeles. Eli Ipp has research funding from Eyenuk, Inc. The other authors declare no duality of interests.

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Mehranbod, C., Genter, P., Serpas, L. et al. Automated Reminders Improve Retinal Screening Rates in Low Income, Minority Patients with Diabetes and Correct the African American Disparity. J Med Syst 44, 17 (2020). https://doi.org/10.1007/s10916-019-1510-3

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