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

项目摘要 到2010年，原发性开角型青光眼(POAG)的病例数量将增加250% 2050年，直接影响到700多万人的生命。这些号码是专门针对POAG的 不包括许多因眼球抬高而接受监测和治疗的人 压力或青光眼可疑状态，这与POAG都可以考虑 青光眼相关疾病(GAD)。发展高质量、可获得性和 对于这些人来说，具有成本效益的眼睛护理战略至关重要。 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，出现的时间早了大约10年。这 研究计划寻求实施和评估基于远程医疗的检测和 联邦会诊患者中广泛性眼病和其他眼病的管理策略 位于阿拉巴马州黑带地区农村的合格健康中心(FQHC)。这 该地区的特点是非洲裔美国人在 美国；高贫困率、失业率和未参保率；教育不足 系统、交通和社区资源；很少有验光师，他们主要 在零售场所执业；没有专门治疗青光眼的眼科医生。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- 资助改善社区的眼科护理质量和可获得性(平等) 这项研究使用了综合远程视神经评估(RONA)。这项建议 将对相等方法进行修改，使用可移植的 更适用于农村的视功能和视神经视网膜结构 资源有限的地点。我们还将确定和评估补救措施 转诊和后续预约患者遵医障碍的策略 通过将经济激励的有效性与经过验证的患者进行比较 教育计划与单独有效的患者教育计划相比。使用这个 FQHC内的计划将使全国范围内的扩展到农村和城市 服务不足的地点，因为这些中心在 在服务不足的地区，每年在12000多个地点治疗2700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.