Radgoudarzi Niloofar, Gregg Chhavi, Quackenbush Quinn, Yiu Glenn, Freeby Matthew, Su George, Baxter Sally, Thorne Christine, Willard-Grace Rachel
Ophthalmology, University of California San Diego Health, San Diego, USA.
Informatics Services, University of California San Diego Health, San Diego, USA.
Cureus. 2024 Jul 9;16(7):e64179. doi: 10.7759/cureus.64179. eCollection 2024 Jul.
Background This study aimed to investigate the rationale, barriers, and facilitators of teleretinal camera implementation in primary care and endocrinology clinics for diabetic retinopathy (DR) screening across University of California (UC) health systems utilizing the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Methodology Institutional representatives from UC Los Angeles, San Diego, San Francisco, and Davis participated in a series of focus group meetings to elicit implementation facilitators and barriers for teleophthalmology programs within their campuses. Site representatives also completed a survey regarding their program's performance over the calendar year 2022 in the following areas: DR screening camera sites, payment sources and coding, screening workflows including clinical, information technology (IT), reading, results, pathologic findings, and follow-up, including patient outreach for abnormal results. Focus group and survey results were mapped to the EPIS framework to gain insights into the implementation process of these programs and identify areas for optimization. Results Four UC campuses with 20 active camera sites screened 7,450 patients in the calendar year 2022. The average DR screening rate across the four campuses was 55%. Variations between sources of payment, turn-around time, image-grading structure, image-report characteristics, IT infrastructure, and patient outreach strategies were identified between sites. Closing gaps in IT integration between data systems, ensuring the financial sustainability of the program, and optimizing patient outreach remain primary challenges across sites and serve as good opportunities for cross-institutional learning. Conclusions Despite the potential for long-term cost savings and improving access to care, numerous obstacles continue to hinder the widespread implementation of teleretinal DR screening. Implementation science approaches can identify strategies for addressing these challenges and optimizing implementation.
背景 本研究旨在利用探索、准备、实施和维持（EPIS）框架，调查加利福尼亚大学（UC）医疗系统中初级保健和内分泌诊所实施远程视网膜相机进行糖尿病视网膜病变（DR）筛查的基本原理、障碍和促进因素。方法 来自加州大学洛杉矶分校、圣地亚哥分校、旧金山分校和戴维斯分校的机构代表参加了一系列焦点小组会议，以找出其校园内远程眼科项目实施的促进因素和障碍。各站点代表还完成了一项关于其项目在2022日历年度以下方面表现的调查：DR筛查相机站点、支付来源和编码、筛查工作流程，包括临床、信息技术（IT）、阅片、结果、病理发现以及随访，包括针对异常结果的患者外展。焦点小组和调查结果被映射到EPIS框架，以深入了解这些项目的实施过程，并确定优化领域。结果 2022日历年度，四个拥有20个活跃相机站点的加州大学校园共筛查了7450名患者。四个校区的平均DR筛查率为55%。各站点之间在支付来源、周转时间、图像分级结构、图像报告特征、IT基础设施和患者外展策略方面存在差异。弥合数据系统之间的IT整合差距、确保项目的财务可持续性以及优化患者外展仍然是各站点面临的主要挑战，也是跨机构学习的良好机会。结论 尽管远程视网膜DR筛查具有长期节省成本和改善医疗服务可及性的潜力，但众多障碍仍在阻碍其广泛实施。实施科学方法可以确定应对这些挑战和优化实施的策略。
