Improving Access to and Quality of Eye Care in an At-Risk, Underserved Population

描述(由申请人提供)：我们TRC网络中心的重点是40岁人口中的一个高风险但服务不足的部分，即居住在阿拉巴马州杰斐逊县的非裔美国人，他们中的许多人没有保险。非裔美国人的视力受损和眼病的发病率是老年白人的两倍，尤其是青光眼和糖尿病视网膜病变。公共卫生面临的挑战是，如果这些眼睛问题被及早发现，这种疾病和视力损害中的大部分将是可逆的，并且可以通过现有的眼科治疗进行预防。之前的研究表明，非洲裔美国成年人不太可能接受常规的、全面的眼睛护理，因为新出现的眼睛疾病可以被及时发现和治疗。眼疾和视力障碍的个人负担很重。视力障碍导致难以维持高质量的生活，并阻碍阅读、行动、财务管理和参与社会活动。视力障碍者患抑郁症、交通困难、失业、被安置在长期护理中心、受伤和死亡的风险增加。作为一个社会，视力障碍的经济负担是惊人的。据估计，美国成年人视力问题每年造成的损失约为514亿美元。许多护理障碍可能是非裔美国人视力损害率恶化的根本原因，包括成本、缺乏医疗保险、沟通、信任，以及他们对如何预防眼病了解不足。医疗保健系统本身的特点无疑起到了推波助澜的作用，例如，在高危人群所在的地理区域工作的眼科护理提供者短缺，接受未参保患者的诊所短缺，这些诊所的工作人员资金不足，以及在遵循首选的实践模式以改善结果方面面临相关挑战。我们在阿拉巴马州拥有独特的资源来解决这些紧迫的问题，通过阿拉巴马大学伯明翰分校(UAB)和库珀绿色医院/杰斐逊医疗系统(CGH/JHS)之间的合作。CGH/JHS为杰斐逊县的所有居民提供服务，无论他们的支付能力如何。在CHS/JHS诊所就诊的成年患者中，约80%是非裔美国人，约70%没有任何医疗保险。超过60%的人被诊断出患有青光眼或糖尿病，或者两者兼而有之。利用CGH/JHS行政数据库和我们在诊所研究个别患者的能力，我们的研究中心将提供如何改善这些服务不足的人群获得眼科护理的机会和质量的信息。研究将集中在原发开角型青光眼、糖尿病眼部护理和需要康复服务的视障人士。我们的中心还将参与TRC网络范围的研究，该研究将与其他网络中心和疾控中心合作设计。

DESCRIPTION (provided by applicant): The focus of our TRC network center is on a high-risk yet underserved segment of the e 40 years old population, namely African Americans residing in Jefferson County, Alabama, many of who are uninsured. Rates of vision impairment and eye disease among African Americans are two times higher than those of older whites, especially glaucoma and diabetic retinopathy. The public health challenge is that if these eye problems had been detected early, much of this disease and vision impairment would be reversible and preventable with currently available ophthalmic treatments. Previous research has suggested that African Americans adults are less likely to receive routine, comprehensive eye care, when newly emerging eye conditions could be detected and treated in a timely fashion. The personal burden of eye disease and vision impairment is heavy. Vision impairment causes difficulties in maintaining a high quality of life and hampers reading, mobility, financial management, and engagement in social activities. Persons with vision impairment are at increased risk for depression, transportation challenges, being unemployed, placement into long-term care, injury, and mortality. As a society, the economic burden of vision impairment is staggering. The annual cost of adult vision problems in the U.S. has been estimated to be about $51.4 billion. Many barriers to care likely underlie the exacerbated vision impairment rates in African Americans, including cost, lack of health insurance, communication, trust, and their having an inadequate understanding of how eye diseases can be prevented. Characteristics of the healthcare system itself undoubtedly contribute, such as a shortage of eye care providers who work in geographic areas with high-risk populations, a shortage of clinics that accept patients who are uninsured, insufficient funds to staff these clinics, and associated challenges in following preferred practice patterns to improving outcomes. We have a unique resource here in Alabama to address these pressing issues, through a partnership between the University of Alabama at Birmingham (UAB) and the Cooper Green Hospital/Jefferson Health System (CGH/JHS). CGH/JHS serves all residents of Jefferson County regardless of their ability to pay. About 80% percent of adult patients seen at the CHS/JHS clinics are African American and about 70% have no health insurance whatsoever. Over 60% have been diagnosed with glaucoma or have diabetes or both. Using the CGH/JHS administrative database and our ability to study individual patients in the clinics, our research center will provide information on how to improve access to and the quality of eye care for this underserved population. Studies will focus on primary open angle glaucoma, diabetic eye care, and visually impaired persons in need of rehabilitation services. Our center will also participate in TRC network-wide studies to be designed collaboratively with the other network centers and CDC.