(1035) Impact of a Diabetic Retinal Exam Screening Program on Quality Measure Gaps for Diabetic Retinopathy at a Family Medicine Practice: An Interprofessional Initiative

Objectives: Diabetic retinopathy is one of the most common complications of uncontrolled diabetes mellitus and is also one of the primary causes of visual impairment. For this reason, the American Diabetes Association recommends annual retinal exams for patients with diabetes. Receipt of this annual diabetic retinal exam (DRE) is a Healthcare Effectiveness Data and Information Set (HEDIS) measure under Diabetes Comprehensive Care, and the percentage of patients with diabetes aged 18-75 receiving this exam within a 12-month period is used to evaluate both payors and providers. Social determinants of health (SDOH) disproportionately affect the prevalence of retinopathy and annual screening rates for patients living in rural areas, on Medicaid, or of lower socioeconomic status. The purpose of this project is to describe the implementation of an interprofessional DRE screening program at a family medicine practice and its impact on the number of quality measure gaps resolved. Secondary objectives include describing the number of patients identified with an abnormal DRE evaluation as well as describing patient satisfaction with the program.

Methods: This descriptive study was conducted at a family medicine center in Southwestern PA in a rural and medically underserved community. The clinic partnered with a local Medicaid plan to obtain a list of patients at the practice with a quality measure gap for their annual DRE. The plan also loaned the family medicine center a RetinaVue 700® Imager to hold “DRE Clinics” within the office. A board-certified ophthalmologist provided by the plan evaluated retinal photos remotely and sent the results to a PGY2 family medicine resident. The resident then communicated these results to the patients via phone. In order to set up these appointments, student pharmacists contacted patients with gaps via phone to screen for eligibility to participate in the DRE clinic. These exams were conducted by student pharmacists at the family medicine center over the course of nine days. Throughout the prescreening and screening processes, the family medicine center recorded the number of patients who had their annual DRE gap closed. Students contacted eye providers via phone to request records for patients who reported already completing a DRE within the past year. Patients without contraindications to the DRE exam and who did not already receive an exam within the past year were scheduled during designated “DRE Clinic” times. Patients completing the exam on site were educated on the importance of retinopathy screening, were given a list of in-network eye care providers for future visits, and were invited to take a one-question survey about the factors that most impacted their decision to schedule an appointment at the clinic.

Results: A total of 78 patients were initially on the DRE gap list provided by the plan. 8 patients reported having an eye exam completed within the prior year and documentation confirming receipt was obtained for 3 of these patients. A total of 24 patients agreed to DRE screenings in office and of these, 12 completed the exam. Screening results and data related to patient satisfaction are in progress and will be presented at APhA 2024.

Conclusions: Offering an in-office DRE clinic may be an effective strategy to overcome barriers to retinopathy screening among underserved patients in a rural family medicine practice and to close quality measure gaps for annual eye exams in patients with diabetes. The impact of this program on identifying retinopathy will be determined.