Torres Diaz Alejandra, Lock Loren J, Molfenter Todd D, Mahoney Jane E, Boss Deanne, Bjelland Timothy D, Liu Yao
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, 2870 University Ave., Ste. 206, Madison, WI, 53705, USA.
Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
Implement Sci Commun. 2021 Jul 6;2(1):74. doi: 10.1186/s43058-021-00175-0.
Teleophthalmology provides evidence-based, telehealth diabetic retinopathy screening that is underused even when readily available in primary care clinics. There is an urgent need to increase teleophthalmology use in the US primary care clinics. In this study, we describe the development of a tailored teleophthalmology implementation program and report outcomes related to primary care provider (PCP) adoption.
We applied the 5 principles and 10 steps of the NIATx healthcare process improvement model to develop and test I-SITE (Implementation for Sustained Impact in Teleophthalmology) in a rural, the US multi-payer health system. This implementation program allows patients and clinical stakeholders to systematically tailor teleophthalmology implementation to their local context. We aligned I-SITE components and implementation strategies to an updated ERIC (Expert Recommendations for Implementing Change) framework. We compared teleophthalmology adoption between PCPs who did or did not participate in various components of I-SITE. We surveyed PCPs and clinical staff to identify the strategies they believed to have the highest impact on teleophthalmology use.
To test I-SITE, we initiated a year-long series of 14 meetings with clinical stakeholders (n=22) and met quarterly with patient stakeholders (n=9) in 2017. Clinical and patient stakeholder groups had 90.9% and 88.9% participant retention at 1 year, respectively. The increase in teleophthalmology use was greater among PCPs participating in the I-SITE implementation team than among other PCPs (p < 0.006). The proportion of all PCPs who used the implementation strategy of electing diabetic eye screening for their annual performance-based financial incentive increased from 0% (n=0) at baseline to 56% (n=14) following I-SITE implementation (p = 0.004). PCPs and clinical staff reported the following implementation strategies as having the highest impact on teleophthalmology use: reminders to ask patients about diabetic eye screening during clinic visits, improving electronic health record (EHR) documentation, and patient outreach.
We applied the NIATx Model to develop and test a teleophthalmology implementation program for tailored integration into primary care clinics. The NIATx Model provides a systematic approach to engaging key stakeholders for tailoring implementation of evidence-based telehealth interventions into their local context.
远程眼科提供基于证据的远程医疗糖尿病视网膜病变筛查服务，即便在基层医疗诊所中唾手可得，其使用率仍较低。美国基层医疗诊所迫切需要提高远程眼科服务的使用率。在本研究中，我们描述了一个量身定制的远程眼科实施项目的开发过程，并报告了与初级保健提供者（PCP）采用情况相关的结果。
我们应用NIATx医疗流程改进模型的5项原则和10个步骤，在美国农村的一个多支付方医疗系统中开发并测试I-SITE（远程眼科持续影响实施项目）。该实施项目使患者和临床利益相关者能够根据当地情况系统地调整远程眼科的实施。我们将I-SITE的组成部分和实施策略与更新后的ERIC（实施变革专家建议）框架进行了匹配。我们比较了参与或未参与I-SITE各个组成部分的PCP之间远程眼科服务的采用情况。我们对PCP和临床工作人员进行了调查，以确定他们认为对远程眼科服务使用影响最大的策略。
为了测试I-SITE，我们在2017年与临床利益相关者（n = 22）发起了为期一年的14次会议系列，并每季度与患者利益相关者（n = 9）会面。临床和患者利益相关者群体在1年时的参与者保留率分别为90.9%和88.9%。参与I-SITE实施团队的PCP中远程眼科服务的使用增加幅度大于其他PCP（p < 0.006）。在I-SITE实施后，所有将为基于年度绩效的财务激励而选择糖尿病眼部筛查作为实施策略的PCP比例从基线时的0%（n = 0）增加到56%（n = 14）（p = 0.004）。PCP和临床工作人员报告了以下实施策略对远程眼科服务使用影响最大：在门诊就诊时提醒询问患者糖尿病眼部筛查情况、改善电子健康记录（EHR）文档记录以及患者外展服务。
我们应用NIATx模型开发并测试了一个远程眼科实施项目，以使其能够量身定制地融入基层医疗诊所。NIATx模型提供了一种系统方法，让关键利益相关者参与进来，以便根据当地情况量身定制基于证据的远程医疗干预措施的实施。
