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

项目摘要/摘要 在工作年龄的美国成年人中，糖尿病视网膜病变仍然是导致失明的主要原因，尽管 具有里程碑意义的国家眼科研究所(NEI)的临床试验表明，早期发现和治疗可以降低患上糖尿病的风险 严重的视力损失超过90%。然而，在美国坚持每年进行糖尿病视网膜病变筛查的情况仍然存在 农村社区不到一半的患者。眼部远程医疗(即远程眼科)基本上可以 提高糖尿病视网膜病变筛查率，预防失明。然而，通常使用非常有限的 即使在多方付费医疗系统中建立了远程眼科计划之后，这项技术也是如此 大多数美国人都得到了他们的照顾。克服在农村使用远程眼科技术的主要障碍 多付款人初级保健诊所，PI开发并试行实施，以维持在 远程眼科(I-SITE)荣获NEI K23职业发展奖。I-SITE是第一个实施方案 专门为克服远程眼科使用障碍而量身定做的远程眼科融入农村小学 护理诊所工作流程。这项研究是一项多中心随机对照试验，旨在：(1)检验 I-SITE的有效性，(2)确定区别高的解释性因素和实施部分 在I-SITE实施后，在农村卫生系统中使用较低的远程眼科，以及(3)评估 实施成本。我们假设I-SITE将保持显著的糖尿病眼筛查率增加 在18个月时，与通常的远程眼科护理相比。 这项UG1提案直接回应了NEI战略计划的多个要素，包括 强调远程医疗、糖尿病视网膜病变和扩大农村人口获得眼科护理的机会。这 研究将促进远程医疗技术在农村多付费初级保健诊所的有效推广 提高糖尿病视网膜病变筛查率。眼部远程医疗的有效整合和放大 将极大地扩大数百万美国农村人的眼睛护理机会。这将是防止可避免的关键 克服眼科护理提供者短缺，满足日益增长的眼科需求而致盲 糖尿病患病率预计大幅增加所导致的筛查。当我们面对 对我国卫生系统的前所未有的挑战，在我们的历史上从未有过需要 向远程医疗的快速过渡更加紧迫。我们的研究将提供关于 成功将远程医疗技术转化为广泛临床所需的方法和因素 提高全国公共卫生水平的实践活动。

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.