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识别和比较联邦合格健康中心(FQHC)对糖尿病视网膜病变的眼部护理筛查和治疗，同时控制一系列社会经济、人口和其他相关因素。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、低收入和未参保人口中的流行情况，人们知之甚少。芝加哥是美国人口第三多的城市，在城市范围内有270万人，在大都市地区约有1000万人。它包括多个世界级的医疗中心，70多个不同的社区，以及与该国一些最大的健康差距有关的最隔离的地区。FQHC是以社区为基础的组织，向所有年龄段的人提供标准化的全面护理服务，无论他们的支付能力如何，是卫生保健安全网的关键组成部分。许多FQHC患者是少数族裔，没有保险，否则将无法获得基本医疗护理。提供对筛查、诊断和治疗(如果有)的洞察将有助于确定最需要立即干预的领域。极具创新性的芝加哥医疗信息技术区域推广中心(CHITREC)是一个现有的数据库，它提供了在零散的医疗保健系统中跟踪个别患者(芝加哥超过200万人)的机会，以更好地了解糖尿病眼部疾病、筛查和治疗在服务不足和少数族裔中的情况。我们的目标是确定CHITREC中所有被诊断为糖尿病的患者，并将他们分为三组(未使用FQHC的组，使用FQHC但没有眼科医生或验光师在场的组，以及使用FQHC但有眼科医生或验光师在场的组)，并评估这三组之间的年度眼科检查、疾病发现和治疗率的差异。目标1将通过每年的眼睛护理检查来估计糖尿病患者的数量，目标2将估计糖尿病视网膜病变的发现、治疗率和治疗时间。我们将使用描述性技术和回归模型来研究考虑到地点和位置、社会经济和人口因素的利用和治疗。这项提议允许进行战略规划，并进行分析，以确定最需要按计划安置和注入更多眼科医生和资源的领域，以改善已确定的健康差距。随后，我们将测试非Mydratic摄像机的使用作为一项等效性试验，作为识别和分析服务不足的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.