Using Telemedicine to Prevent Blindness in an At-Risk Rural Alabama Population

项目摘要 原发性开角型青光眼（POAG）病例的数量将增加250%， 2050年，直接影响700多万人的生命。这些数字是专门针对POAG的 并且不包括许多因眼内升高而接受监测和治疗的患者， 眼压或青光眼可疑状态，与POAG一起沿着都可以考虑 青光眼相关疾病（GAD）。发展高质量、无障碍、 对这些个体的眼睛护理的成本效益策略是至关重要的。 POAG在非裔美国人中至少高出4-5倍，进展更快， 与欧洲血统的人相比，大约早10年出现。这 研究计划旨在实施和评估基于远程医疗的检测， 在联邦医院就诊的GAD和其他眼病患者的管理策略 位于亚拉巴马黑带地区农村的合格卫生中心（NHC）。这 该地区的特点是非洲裔美国人的最高浓度在 美国;高贫困率、失业率和无保险率;教育不足 系统，交通和社区资源;很少有验光师， 在零售环境中实践;没有专门从事青光眼的眼科医生。我们有 在我们之前的CDC中开发并测试了一种新的多模式远程医疗方法， Eye Care Quality and Accessibility Improvement in the Community（EQUALITY） 使用综合远程视神经评估（RONA）的研究。这项建议 将使用便携式测量方法对平等方法进行修改， 视觉功能、视神经和视网膜结构，更适用于农村 资源有限的地点。我们还将确定和评估补救措施 针对患者坚持转诊和随访预约的障碍的策略 通过比较经济激励沿着的有效性和有效的病人 教育计划与单独的经验证的患者教育计划。使用此 该计划将在全国范围内扩展到农村和城市 由于这些中心提供初级卫生保健服务， 在服务不足的地区，每年在12 000多个地点治疗2 700多万人。

Project Summary The number of primary open angle glaucoma (POAG) cases will increase by 250% by 2050, directly affecting over 7 million lives. These numbers are specifically for POAG and do not include the many who are monitored and treated for elevated intraocular pressure or for glaucoma suspect status, which along with POAG can all be considered glaucoma associated diseases (GAD). Development of high-quality, accessible, and cost-effective strategies for eye care for these individuals is of critical importance. POAG is at least 4-5 times higher in African Americans, progresses more rapidly and appears about 10 years earlier as compared to those of European descent. This research plan seeks to implement and evaluate a telemedicine-based detection and management strategy for GAD and other eye diseases in patients seen at Federally Qualified Health Centers (FQHC’s) located in the rural Alabama Black Belt Region. This region is characterized by one of the highest concentrations of African Americans in the US; high poverty, unemployment, and uninsured rates; inadequate educational systems, transportation and community resources; few optometrists who largely practice in retail settings; and no ophthalmologists specializing in glaucoma. We have developed and tested a novel multimodal telemedicine approach in our prior CDC- funded Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) study that used comprehensive remote optic nerve assessment (RONA). This proposal will employ a modification of the EQUALITY approach using portable measurement of visual function and optic nerve and retinal structure that are more applicable to rural locations with limited resources. We will also identify and evaluate remediation strategies for the barriers to patient adherence with referral and follow-up appointments by comparing the effectiveness of financial incentives along with a validated patient education program versus a validated patient education program alone. Using this program within FQHC’s will enable expansion nationwide into rural and urban underserved locations as these centers provide primary health care services in underserved areas and treat more than 27 million people yearly at over 12,000 sites.