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Original Investigation |

Effect of a Teleretinal Screening Program on Eye Care Use and Resources

Joel E. Chasan, MD1; Bill Delaune, PhD2; April Y. Maa, MD1,3; Mary G. Lynch, MD1,3
[+] Author Affiliations
1Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
2Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia
3Ophthalmology Section, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
JAMA Ophthalmol. 2014;132(9):1045-1051. doi:10.1001/jamaophthalmol.2014.1051.
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Importance  Telemedicine is a useful clinical method to extend health care to patients with limited access. Minimal information exists on the subsequent effect of telemedicine activities on eye care resources.

Objective  To evaluate the effect of a community-based diabetic teleretinal screening program on eye care use and resources.

Design, Setting, and Participants  The current study was a retrospective medical record review of patients who underwent diabetic teleretinal screening in the community-based clinics of the Atlanta Veterans Affairs Medical Center from October 1, 2008, through March 31, 2009, and who were referred for an ophthalmic examination in the eye clinic.

Exposures  Clinical medical records were reviewed for a 2-year period after patients were referred from teleretinal screening. The following information was collected for analysis: patient demographics, referral and confirmatory diagnoses, ophthalmology clinic visits, diagnostic procedures, surgical procedures, medications, and spectacle prescriptions.

Main Outcomes and Measures  The accuracy between referring and final diagnoses and the eye care resources that were used in the care of referred patients.

Results  The most common referral diagnoses were nonmacular diabetic retinopathy (43.2%), nerve-related disease (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%), and diabetic macular edema (5.6%). The percentage of agreement among these 5 visually significant diagnoses was 90.4%, with a total sensitivity of 73.6%. Diabetic macular edema required the greatest number of ophthalmology clinic visits, diagnostic tests, and surgical procedures. Using Medicare cost data estimates, the mean cost incurred during a 2-year period per patient seen in the eye clinic was approximately $1000.

Conclusions and Relevance  Although a teleretinal screening program can be accurate and sensitive for multiple visually significant diagnoses, measurable resource burdens should be anticipated to adequately prepare for the associated increase in clinical care.

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Figure 1.
Eye Care Resource Use by Diagnostic Category for 2 Years After Teleretinal Screening

The bar graph shows the mean resource use per patient by primary diagnosis category for the 260 patients who underwent an ophthalmic examination in the eye clinic during a 2-year period after teleretinal imaging.

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Figure 2.
Mean 2-Year Cost per Patient Seen in the Eye Clinic

The bar graph shows the mean approximate cost to provide ophthalmic care to patients referred from diabetic teleretinal screening as estimated through Medicare physician fee schedules. Diabetic macular edema was the most costly condition to treat.

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