Sustainable Community Clinic Telemedicine-Based Glaucoma Screening

项目摘要 迫切需要研究创新战略，以更好地吸引最有可能患上艾滋病的人群 青光眼患者视力丧失，最不可能求助于眼科护理提供者。社区诊所如 联邦合格的健康中心或免费诊所为生活在贫困中的人提供护理。因为这些 人们不成比例地是少数族裔和民族，社区诊所为那些 有更高的风险：1)患有青光眼，2)没有得到足够的青光眼专业治疗。青光眼 尽管存在有效的治疗方法，但仍是导致失明的主要原因。我们的目标是解决 关键的后勤和心理社会障碍--成本、运输、对供应商的信任以及对此的怀疑 一种无症状的疾病将导致失明--这限制了弱势群体获得青光眼护理的机会。 科学前提是基于远程医疗方法对青光眼有效的证据。 筛查改善了弱势人群获得服务的机会。我们的中心假设是 通过社区义诊提供全面的青光眼筛查和后续护理 基础设施将建立一种可持续的方法来减少后勤和心理社会问题，并 改善这一弱势群体的视力结果。我们将使用社区参与的研究策略来 通过半结构化了解未参保和参保不足的成年人获得眼科护理的关键障碍 采访。我们将在学术(密歇根大学，密歇根大学)和 社区诊所(密歇根州伊普西兰蒂的希望诊所和密歇根州弗林特的汉密尔顿诊所)成立社区咨询 委员会邀请这些社区参与青光眼筛查工作。我们将使用基于远程医疗的 在两家诊所进行青光眼筛查。眼科技术人员将收集自动眼部筛查 并将数据传输给UM的眼科医生，他负责解释筛查 信息，并远程传达建议的后续护理。眼科医生资源将得到更多利用 效率高，因为它们不需要与患者共同定位以提供高质量的筛查护理。这个 患者的时间负担也得到了减轻。筛查是在当地可信的地点进行的，只有患者 那些疾病筛查呈阳性的人去专业诊所旅行。低成本的眼镜将通过公共渠道提供 可用的基础设施。我们将评估青光眼和其他致盲眼病的患病率，以及 每发现一个病例的筛查成本。我们将使用社区意见来提炼基于电子健康的个性化 咨询和教育计划，以提高对青光眼后续护理建议的遵从性。我们 将评估这一干预措施与标准教育相比对后续依从性的影响 随机对照试验。将对方案成本进行评估。这项提议是迈向我们长期- 长期目标是通过利用社区参与的研究来消除青光眼预后的差异 为弱势群体提供专门护理。

Project Summary There is a critical need to study innovative strategies to better engage populations of people most at risk of glaucomatous vision loss and least likely to have access to an eye care provider. Community clinics such as federally qualified health centers or free clinics provide care for people who live in poverty. Because these people are disproportionately of minority race and ethnicity, community clinics provide care for people who are at higher risk of: 1) having glaucoma and 2) not getting adequate specialty treatment for glaucoma. Glaucoma remains a leading cause of blindness even though effective treatments exist. Our objective is to address the critical logistical and psychosocial barriers – cost, transportation, trust in the provider and skepticism that that an asymptomatic disease will lead to blindness – that limit access of vulnerable populations to glaucoma care. The scientific premise is based on evidence of the effectiveness of telemedicine approaches to glaucoma screening that have improved access to services for vulnerable populations. Our central hypothesis is that providing comprehensive glaucoma screening and follow-up care through the community-based free clinic infrastructure will establish a sustainable approach to decreasing logistical and psychosocial issues and improve vision outcomes for this vulnerable population. We will use community-engaged research strategies to understand key barriers to accessing eye care for uninsured and underinsured adults through semi-structured interviews. We will build upon a trusting partnership among academic (University of Michigan, UM) and community clinics (Hope Clinic, Ypsilanti, MI and Hamilton Clinic, Flint, MI) by forming a Community Advisory Board to engage these communities in glaucoma screening efforts. We will use a telemedicine-based glaucoma screening approach in the two clinics. Ophthalmic technicians will gather automated eye screening data at the clinic sites and transmit the data to an ophthalmologist at the UM who interprets screening information and conveys recommended follow-up care remotely. Ophthalmologist resources will be used more efficiently, since they do not need to be co-localized with the patient to provide high quality screening care. The burden on patients’ time is also reduced. Screening is conducted locally at trusted locations, and only patients who screen positive for disease travel to specialty clinics. Low-cost glasses will be provided through publicly available infrastructure. We will assess the prevalence of glaucoma and other blinding eye diseases and the screening cost per case detected. We will use community input to refine an eHealth-based personalized counseling and education program to improve adherence to glaucoma follow-up care recommendations. We will evaluate the effect of this intervention on follow-up adherence compared to standard education in a randomized controlled trial. Programmatic costs will be evaluated. This proposal is a first step toward our long- term goal to eliminate disparities in glaucoma outcomes by leveraging community-engaged research to bring specialty care to vulnerable populations.