Diabetic Retinopathy Follow-Up Improved by Electronic Medical Records Program

Electronic medical record (EMR)-based programs can identify patients with diabetic retinopathy (DR) who are lost to follow-up (LTF) and facilitate their re-engagement, according to a study published in Ophthalmic and Physiological Optics. The EMR-based initiative successfully re-engaged 22 out of 78 patients with DR identified as LTF within 1 month of its inception, the report shows.    

The pilot study enlisted providers to review EMRs and re-engage patients with DR seen 1 year previously who failed to return for care within a 6 month period. The investigators used binary logistic regression analysis to identify demographic, clinical, and socio-medical factors associated with being LTF, as well as factors predictive of re-engagement. 

Of the 673 patients with DR, researchers identified 78 (12%) as LTF. The team noted associations between being LTF and younger age (P =.001) and poorly controlled hemoglobin A1c (P =.04) and LDL levels (P <.001). These participants also completed fewer ophthalmology appointments and had less retinal imaging taken the year prior (P <.001 for both). A chart review conducted 1 month after the EMR-based intervention revealed that 22 patients (28%) had been successfully re-engaged by providers, and 56 patients (72%) remained LTF. 

A history of previous treatment for DR was associated with re-engagement by providers (P =.04), according to the report. The LTF rate decreased to 8.3% in 1 month after the provider-based re-engagement initiative, and only 3.6% of the patients remained LTF after 1 year. Factors associated with a lower likelihood of being LTF included more frequent ophthalmology follow-up visits and receiving retinal imaging the year prior, the researchers note.  

“The present study describes the successful implementation of an EMR-based intervention to identify and re-engage patients with DR through a combination of telehealth and office-based recall orders,” according to the researchers. “Such quality improvement efforts not only promote optimal care of patients by potentially reducing vision loss from DR progression, but also serve to maintain clinical productivity and reduce potential medicolegal liability arising from gaps in diabetic eye care.”

Study limitations include its retrospective nature, limited sample size, single center design, and short study duration. 

Reference

Sabharwal S, Kuo KH, Roh S, Ramsey DJ. An initiative to improve follow-up of patients with diabetic retinopathy. Ophthalmic Physiol Opt. Published online May 11, 2022. doi:10.1111/opo.12998