THE COMPARATIVE EFFECTIVENESS OF TELEMEDICINE TO DETECT DIABETIC RETINOPATHY

描述(申请人提供)：糖尿病视网膜病变是工作年龄成年人失明的主要原因，这种疾病和随之而来的失明对美国印第安人和阿拉斯加土著人(AI/AN)的影响不成比例。医疗研究和质量机构报告称，每年糖尿病患者的眼科检查将为政府节省约4.72亿美元。预防视力丧失的基石是每年一次的眼科检查和早期治疗，但只有不到50%的AI/AN糖尿病患者接受年度眼科检查。在西北AI/AN中，43个联邦承认的部落中只有两个有附属临床医生，他们可以提供年度眼科检查，而且许多农村保留地距离城市眼科护理中心很远，这使得糖尿病视网膜病变的常规护理变得复杂。这项建议将解决三个关键的知识空白：1)远程医疗和传统监测方法检测糖尿病视网膜病变的有效性；2)与接受远程医疗和传统监测方法的糖尿病眼部年度检查有关的健康行为因素；3)远程医疗和传统监测方法的成本效益。如果我们能实现接受眼科检查的患者比例即使是很小的增加，这个项目的影响将是巨大的。如果我们表现出检测糖尿病视网膜病变的成本效益和敏感度的提高，这一益处将进一步增加。该项目的未来经验和数据将为国家和全州糖尿病眼科检查指南的变化以及更大规模的随机临床试验提供框架。我们的研究小组的专业知识、往绩记录和已建立的关系使我们处于独特的地位，能够解决这些知识差距，以预防糖尿病视网膜病变导致的失明。

DESCRIPTION (provided by applicant): Diabetic retinopathy is the leading cause of blindness in working-age adults, and both the disease and ensuing blindness disproportionately affect American Indians and Alaskan Natives (AI/AN). The Agency for Healthcare Research and Quality reported that annual diabetic eye exams would save the government an estimated $472 million dollars per year. The cornerstone of prevention of vision loss is annual eye exams and early treatment, but less than 50% of AI/AN diabetic patients receive annual eye exams. Among northwest AI/AN, only two of the 43 federally recognized tribes have affiliated clinicians who can provide yearly eye exams, and the long distance of many rural reservations from urban eye care centers complicates routine care for diabetic retinopathy. This proposal will address three critical gaps in knowledge: 1) the efficacy for detecting diabetic retinopathy with telemedicine and traditional surveillance methods; 2) the health behavior factors related to receiving annual diabetic eye examinations with telemedicine and traditional surveillance methods; and 3) the cost-effectiveness of telemedicine and traditional surveillance methods. The impact of this project will be large if we can achieve even a small increase in the proportion of patients receiving eye exams. This benefit increases further if we show an increase in cost-effectiveness and sensitivity to detecting diabetic retinopathy. Future experiences and data from this project will provide the framework for changes in the national and statewide guidelines in the delivery of diabetic eye exams as well as a larger randomized clinical trial. Our research group's expertise, track record, and established relationships make us uniquely positioned to address these gaps in knowledge to prevent blindness from diabetic retinopathy.