Understanding Diabetic Eye Disease in the Underserved Using Health Data Exchange

描述（由申请人提供）：本提案的总体目标是确定和比较联邦合格健康中心（FQHC）的眼科保健筛查和糖尿病视网膜病变的治疗，同时控制一系列社会经济，人口统计和其他相关因素。糖尿病是美国40岁及以上成年人失明的主要原因。关于糖尿病视网膜病变在不断增长的美国少数民族、低收入和无保险人群中的患病率知之甚少。芝加哥是美国人口第三多的城市，市区人口270万，大都市区人口约1000万。它包括多个世界一流的医疗中心，70多个不同的社区和最隔离的地区，这些地区与该国一些最大的健康差距有关。家庭健康保健中心是社区组织，向所有年龄的人提供标准化的综合保健服务，无论其支付能力如何，是保健安全网的重要组成部分。许多FQHC患者是少数民族，没有保险，否则将无法获得基本医疗保健。提供对筛查、诊断和治疗（如果有的话）的深入了解将有助于确定最需要立即干预的领域。高度创新的芝加哥健康信息技术区域推广中心（CHITREC）是一个现有的数据库，提供了在分散的医疗保健系统中跟踪个体患者（芝加哥超过200万）的机会，以更好地了解糖尿病眼病，筛查和治疗服务不足和少数民族。我们的目的是确定所有被诊断为糖尿病的CHITREC患者，并将他们分为三组（非FQHC使用组，在没有眼科医生或验光师在场的情况下使用FQHC，以及在有眼科医生或验光师在场的情况下使用FQHC），并评估这三组之间年度眼科检查率，疾病检出率和治疗率的差异。Aim 1将估计每年进行眼科检查的糖尿病患者数量，Aim 2将估计糖尿病视网膜病变的检出率、治疗率和治疗时间。我们将使用描述技术和回归模型来研究场地和位置、社会经济和人口因素的利用和处理。这一建议允许进行战略规划和分析，以确定最需要计划安置和注入更多眼科医生和资源的地区，以改善已确定的健康差距。随后，我们将测试使用非液压摄像机作为等效试验，作为识别和分析的服务不足患者的长期成本效益筛查策略。

DESCRIPTION (provided by applicant): The overall objective of this proposal is identify and compare Federally Qualified Health Centers (FQHC) eye care screening and treatment for diabetic retinopathy while controlling for an array of socio-economic, demographic and other related factors. Diabetes is the leading cause of blindness among United States (US) adults 40 years and older. Little is known about the prevalence of diabetic retinopathy in the growing US minority, low-income, and uninsured population. Chicago is the third most populous city in the US and comprises 2.7 million people within the city limits, and approximately 10 million in the metropolitan area. It includes multiple world class medical centers, over 70 distinct communities and most segregated areas associated with some of the largest health disparities in the country. The FQHCs are community-based organizations that provide standardized comprehensive care services to persons of all ages, regardless of their ability to pay, and are a critical component o the health care safety net. Many FQHC patients are minorities, do not have insurance, and would otherwise lack access to basic medical care. Providing insight into screening, diagnosis, and treatment (if any) will help to identify areas with greatest need for immediate intervention. The highly innovative Chicago Health Information Technology Regional Extension Center (CHITREC) is an existing database and offers the opportunity to track individual patients (over 2 million in the city of Chicago) across the fragmented health care system to better understand diabetic eye disease, screening, and treatments in the underserved and minorities. Our aims seek to identify all patients in CHITREC with a diagnosis of diabetes and classify them into three groups (non-FQHC utilization group, FQHC utilization without the presence of an ophthalmologist or optometrist, and FQHC utilization with the presence of an ophthalmologist or optometrist) and assess the difference in the rates of annual eye exams, disease detection, and treatment among these three groups. Aim 1 will estimate the number of diabetics with an annual eye care exam and Aim 2 will estimate the diabetic retinopathy detection, treatment rate and time to treatment. We will use descriptive techniques and regression models to study utilization and treatments accounting for the site and location, socio-economic, and demographic factors. This proposal allows for the strategic planning with analyses aimed at identifying the areas with the greatest need for the planned placement and infusion of additional ophthalmologists and resources directed at ameliorating the identified health disparities. Subsequently we shall test the use of non-mydratic cameras as an equivalence trial as a long-term cost effective screening strategy for the underserved patients identified and analyzed.