I-TRUST: Implementation of Teleophthalmology in Rural Health Systems Study

I-TRUST：远程眼科在农村卫生系统研究中的实施

• 批准号: 10874998
• 负责人: Yao Liu
• 金额: $ 9.25万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10874998
• 关键词: Acute; Address; Adherence; Adult; Affect; Age; American; Area; Blindness; Caring; Clinical Trials; Cluster randomized trial; Communities; Data; Diabetes Mellitus; Diabetic Retinopathy; Early Diagnosis; Early treatment; Effectiveness; Elements; Eye; Face; Future; Goals; Guidelines; Health Services Accessibility; Health Technology; Health system; Healthcare Systems; Human Resources; Insurance Coverage; Interview; K-Series Research Career Programs; Knowledge; Measures; Mentored Patient-Oriented Research Career Development Award; Methods; National Eye Institute; Outcome; Outcome Measure; Patients; Prevalence; Primary Care; Primary Health Care; Public Health; Randomized, Controlled Trials; Recording of previous events; Research; Retina; Retinal Diseases; Risk; Risk Reduction; Rural; Rural Community; Rural Health; Rural Population; Screening Result; Strategic Planning; Structure; Technology; Telemedicine; Testing; Time; Translating; Translations; Travel; United States National Institutes of Health; Urban Population; Vision; Visual; Visual impairment; Work; acceptability and feasibility; care providers; clinical practice; design; diabetic; effectiveness evaluation; effectiveness testing; evidence base; implementation cost; implementation evaluation; implementation measures; improved; insight; meetings; pilot test; prevent; primary care clinic; primary care provider; primary outcome; programs; rural Americans; rural patients; scale up; screening; secondary outcome; telehealth; teleophthalmology; treatment as usual; urban underserved

PROJECT SUMMARY/ABSTRACT Among working-age U.S. adults, diabetic retinopathy remains the leading cause of blindness despite landmark National Eye Institute (NEI) clinical trials showing that early detection and treatment reduce the risk of severe vision loss by over 90%. Yet adherence with yearly diabetic retinopathy screening in the U.S remains below half of patients in rural communities. Ocular telemedicine (i.e. teleophthalmology) can substantially increase diabetic retinopathy screening rates and prevent blindness. However, there is often very limited use of this technology even after a teleophthalmology program is established in multi-payer health systems, where the majority of Americans receive their care. To overcome major barriers identified for teleophthalmology use in rural multi-payer primary care clinics, the PI developed and piloted Implementation to Sustain Impact in Teleophthalmology (I-SITE) in a NEI K23 Career Development Award. I-SITE is the first implementation program specifically designed to overcome barriers to teleophthalmology use by tailoring its integration into rural primary care clinic workflows. The proposed study is a multi-center randomized controlled trial aiming to: (1) test the effectiveness of I-SITE, (2) identify explanatory factors and implementation components that distinguish high and low teleophthalmology use in rural health systems following I-SITE implementation, and (3) evaluate implementation costs. We hypothesize that I-SITE will sustain significant diabetic eye screening rate increases at 18 months compared to usual care teleophthalmology. This UG1 proposal directly responds to multiple elements of the NEI Strategic Plan, including areas of emphasis in telemedicine, diabetic retinopathy, and expanding access to eye care in rural populations. This research will facilitate the effective translation of telemedicine technology in rural multi-payer primary care clinics to improve diabetic retinopathy screening rates. The effective integration and scale-up of ocular telemedicine would greatly expand eye care access for millions of rural Americans. This will be critical for preventing avoidable blindness by overcoming the shortage of eye care providers and meeting the increased demand for eye screening resulting from major projected increases in diabetes prevalence. As we face unprecedented challenges to our nation's health systems, never before in our history has the need for a rapid transition to telehealth been more acute. Our study will provide vital knowledge regarding the methods and factors needed to successfully translate telehealth technology into widespread clinical practice for improving public health nationwide.

项目概要/摘要 在美国工作年龄成年人中，糖尿病视网膜病变仍然是导致失明的主要原因 具有里程碑意义的国家眼科研究所 (NEI) 临床试验表明，早期发现和治疗可降低患眼病的风险 严重视力丧失90%以上。然而，美国仍坚持每年进行糖尿病视网膜病变筛查 农村社区的患者不到一半。眼科远程医疗（即远程眼科）可以显着 提高糖尿病视网膜病变筛查率并预防失明。然而，其用途往往非常有限 即使在多支付者卫生系统中建立了远程眼科计划之后，这项技术仍然存在，其中 大多数美国人都得到他们的照顾。克服远程眼科在农村使用的主要障碍 多支付者初级保健诊所，PI 制定并试点实施以维持影响 远程眼科 (I-SITE) 荣获 NEI K23 职业发展奖。 I-SITE是第一个实施计划 专门设计用于通过将远程眼科融入农村小学来克服远程眼科使用的障碍 护理诊所工作流程。拟议的研究是一项多中心随机对照试验，旨在：（1）测试 I-SITE 的有效性，(2) 确定区分高水平的解释因素和实施组件 实施 I-SITE 后，农村卫生系统中远程眼科的使用率较低，以及 (3) 评估 实施成本。我们假设 I-SITE 将显着提高糖尿病眼部筛查率 与常规护理远程眼科相比，在 18 个月时。 该 UG1 提案直接响应 NEI 战略计划的多个要素，包括以下领域： 重点关注远程医疗、糖尿病视网膜病变以及扩大农村人口获得眼保健服务的机会。这 研究将促进远程医疗技术在农村多支付初级保健诊所的有效转化 提高糖尿病视网膜病变筛查率。眼科远程医疗的有效整合和规模化 将极大地扩大数百万美国农村地区的眼保健服务。这对于防止可避免的情况至关重要 通过克服眼保健提供者的短缺并满足对眼睛日益增长的需求 预计糖尿病患病率将大幅增加而导致的筛查。当我们面对 我们国家的卫生系统面临着前所未有的挑战，在我们的历史上从未有过这样的需要 向远程医疗的快速过渡更加紧迫。我们的研究将提供有关以下方面的重要知识： 将远程医疗技术成功转化为广泛临床所需的方法和因素 改善全国公共卫生的实践。

项目成果

Factors Influencing Eye Screening Adherence Among Latinx Patients With Diabetes: A Qualitative Study.

• DOI: 10.1167/tvst.12.12.8
• 发表时间: 2023-12-01
• 期刊: TRANSLATIONAL VISION SCIENCE & TECHNOLOGY
• 影响因子: 3
• 作者: Pelayo, Christian;Pinzon, Maria Mora;Lock, Loren J.;Fowlkes, Christiana;Stevens, Chloe L.;Hoang, Johnson;Garcia, Juan L.;Jacobson, Nora A.;Channa, Roomasa;Liu, Yao
• 通讯作者: Liu, Yao