Operational challenges in delivery of a charity care program for diabetic retinopathy screening in an urban setting.
Operational challenges in delivery of a charity care program for diabetic retinopathy screening in an urban setting.
复制标题
DOI：
10.7812/tpp/12-041
复制
发表时间：
2013-01-01
影响因子：
--
通讯作者：
Jager, Rama D
中科院分区：
文献类型：
--
作者：
Chedid, Erica H;Golden, Quin R;Jager, Rama D
简介：芝加哥大学医学院（UCM）与芝加哥家庭健康中心（芝加哥家庭）合作开展糖尿病视网膜病变筛查计划（DRP），这是一项慈善护理计划，旨在筛查未投保和保险不足的糖尿病患者的糖尿病视网膜病变，这是美国可预防视力丧失的主要原因。DRP在整个试点年度都面临着运营挑战：大量的不可分级视网膜图像，阅读视网膜图像和发送结果的周转时间缓慢，不完整的转诊，以及诊断预约的高缺席率。方法：芝加哥家庭召回不可分级图像的患者进行重复成像，并为拍摄图像的工作人员提供定期培训。每周向医生冠军发送电子邮件，提醒他阅读图像，并在他的笔记本电脑上安装图像软件。患者收到提醒卡和预约前和预约后的电话提醒，预约信息与转诊医生共享。UCM诊所是双重预订的，所以病人在转诊后四周内就可以就诊。与UCM/芝加哥家庭团队进行了讨论，强调及时转诊对未就诊率的影响;向转诊医生发送了转诊提醒。结果：在5天内收到了完整的转诊;不可分级图像的总数减少;由于与医生可用性和技术相关的困难，图像报告周转时间仍然是一个挑战;就诊率开始增加。结论：这种干预的方法将很好地转化为其他为城市地区类似患者群体提供护理的项目。
INTRODUCTION: The University of Chicago Medicine (UCM) partners with Chicago Family Health Center (Chicago Family) in the Diabetic Retinopathy Screening Program (DRP), a charity care program to screen uninsured and underinsured patients with diabetes for diabetic retinopathy, which is a leading cause of preventable vision loss in the US. The DRP faced operational challenges throughout its pilot year: a high number of ungradable retinal images, slow turnaround time for reading retinal images and sending results, incomplete referrals, and a high rate of no-shows for diagnostic appointments.APPROACH: Chicago Family recalled patients with ungradable images for repeat imaging, and regular training was provided to staff taking the images. Weekly e-mails were sent to the physician champion reminding him to read images, and image software was installed on his laptop. Patients received reminder cards and preappointment and postappointment phone call reminders, and appointment information was shared with referring physicians. The UCM clinic was double-booked, so patients were seen within four weeks of referral. Discussions were held with UCM/Chicago Family teams to stress the influence of timely referrals on no-show rate; reminders were sent to referring physicians for referrals.RESULTS: Complete referrals were received within five days; the overall number of ungradable images decreased; image report turnaround time continued to be a challenge because of difficulties related to physician availability and technology; show rates began to increase.CONCLUSIONS: The methods of this intervention will translate well to other programs that provide care for similar patient populations in urban areas.