Advancing Integration of Tele-ophthalmology for Diabetic Retinopathy in Rural, Multi-payer Settings

 描述（由申请人提供）：糖尿病视网膜病变仍然是美国工作年龄成年人失明的主要原因，尽管主要的NEI临床试验表明，早期发现和治疗可将严重视力丧失的风险降低90%。在美国，每年糖尿病视网膜病变筛查指南的依从性停滞在50%。眼科远程医疗（即远程眼科学）可以非常有效地提高糖尿病视网膜病变筛查率，但在构成美国大部分医疗保健系统的多付款人医疗系统中，这些计划的利用非常有限。远程眼科学的成功应用存在重大障碍，但这些障碍知之甚少。Liu博士的K23研究计划旨在（1）确定农村多付款人医疗系统中糖尿病视网膜病变远程眼科筛查的初级保健提供者和患者层面的障碍和促进者，（2）开发一个实施包，以克服单一初级保健站点的这些障碍，以及（3）在多个初级保健诊所对该实施方案对糖尿病视网膜病变筛查率的影响进行试点测试。她假设，这一实施方案，结构上完善的框架，以提高遵守糖尿病护理指南和医疗保健过程的改进，将成功地将远程眼科纳入现有的医疗保健系统，并将实现和维持增加糖尿病视网膜病变筛查率。 刘博士的长期职业目标是通过眼科远程医疗扩大眼科护理的覆盖范围，减少服务不足社区的视力丧失。她提出的指导研究和培训将提供进一步的技能，成为一个独立的调查员在眼科健康服务提供与传播和实施科学的新兴领域的额外专业知识。她将通过威斯康星州的大学，包括完成NIH资助的导师和合作者在远程医疗，流行病学，混合方法（即定性和定量），传播和实施，工业/系统工程和卫生服务研究的多学科领域获得丰富的资源。该K23提案直接响应了国家眼科研究所（NEI）健康差异战略计划和国家眼科和视力研究计划（NPEVR）的多个要素。其中包括卫生服务研究、糖尿病视网膜病变和扩大农村服务不足人口的覆盖面等重点领域。NEI健康差距战略计划指出，远程医疗具有巨大的“减少获取差距的潜力”，NPEVR呼吁“扩大远程医疗管理糖尿病视网膜病变的努力......农村和/或服务不足的人口。通过了解如何在多支付方医疗系统中有效整合和利用眼科远程医疗，刘博士的研究将促进远程医疗技术的有效转化，以提高社区糖尿病视网膜病变筛查率。在这项工作的基础上，她计划开发未来的远程医疗筛查和管理协议，用于视力残疾的其他主要原因，如未矫正的屈光不正，黄斑变性和青光眼。眼科远程医疗的进步有可能为数百万美国人提供无与伦比的眼科护理，这些技术的有效转化对于解决健康差距以及满足我们日益增长的需求至关重要。 人口老龄化

 DESCRIPTION (provided by applicant): Diabetic retinopathy remains the leading cause of blindness among working-age U.S. adults despite the fact that major NEI clinical trials show that early detection and treatment reduce the risk of severe vision loss by 90%. Adherence with yearly diabetic retinopathy screening guidelines in the U.S has stagnated at 50%. Ocular telemedicine (i.e. tele-ophthalmology) can be highly effective for increasing diabetic retinopathy screening rates, but there is very limited utilization of these programs in multi-payer health systems, which constitute the majority of U.S. healthcare systems. Significant barriers exist to the successful application of tele-ophthalmology, but these barriers are poorly understood. Dr. Liu's K23 research plan aims to (1) identify primary care provider and patient-level barriers and facilitators to tele-ophthalmology screening for diabetic retinopathy in a rural, multi-payer healt system, (2) develop an implementation package to overcome those barriers at a single primary care site, and (3) pilot-test the impact of this implementation package on diabetic retinopathy screening rates at multiple primary care clinics. She hypothesizes that this implementation package, structured upon well-established frameworks for increasing adherence with diabetes care guidelines and healthcare process improvement, will successfully integrate tele-ophthalmology into the existing healthcare system, and will both achieve and maintain increased diabetic retinopathy screening rates. Dr. Liu's long-term career goal is to reduce vision loss in underserved communities by expanding access to eye care through ocular telemedicine. Her proposed mentored research and training would provide the further skills needed to become an independent investigator in ophthalmic health services delivery with additional expertise in the emerging field of dissemination and implementation science. She will access a wealth of resources through the University of Wisconsin, including accomplished NIH-funded mentors and collaborators in the multidisciplinary fields of telemedicine, epidemiology, mixed methods (i.e. qualitative and quantitative), dissemination and implementation, industrial/systems engineering, and health services research. This K23 proposal directly responds to multiple elements of the National Eye Institute's (NEI) Health Disparities Strategic Plan and National Plan for Eye and Vision Research (NPEVR). These include areas of emphasis in health services research, diabetic retinopathy, and expanding access to rural, underserved populations. The NEI Health Disparities Strategic Plan states that telemedicine has great "potential to reduce access disparities" and the NPEVR calls to "expand efforts in telemedicine to manage diabetic retinopathy...for rural and/or underserved populations." By understanding how to effectively integrate and utilize ocular telemedicine in multi-payer health systems, Dr. Liu's research will facilitate the effective translation of telemedicine technology ino improved diabetic retinopathy screening rates in the community. Building from this work, she plans to develop future telemedicine screening and management protocols for other major causes of visual disability such as uncorrected refractive error, macular degeneration, and glaucoma. Advancements in ocular telemedicine have the potential to provide unparalleled access to eye care for millions of Americans and the effective translation of these technologies will be critical both for addressing health disparities as well as to meet the growing needs of our aging population.