Tele I CARE for Seniors A Teleophthalmology Vision Health Surveillance Service

描述（由申请人提供）：眼疾和视力障碍在老年人口中更为普遍，特别是在老年生活社区，如辅助或独立生活的老年人。视力障碍的老年患者更有可能在日常活动、移动性、疼痛和不适、焦虑、抑郁和自我护理方面出现严重问题。 到2030年，50%的老年人将至少患有一种视觉上严重的眼病，这可能占老年人医疗保健预算的50%左右。对于那些视力丧失的人来说，非视力相关医疗保健的医疗保险费用比没有视力的人高出50%。幸运的是，大多数与年龄有关的眼部疾病的视力丧失可以通过适当的预防措施来治疗和/或避免-特别是如果早期发现。因此，老年人早期发现眼疾既有生活质量又有成本优势。然而，充其量只有60%的被保险人定期进行眼科检查。本研究的目的是确定使用视网膜摄像机结合个性化患者教育提供视力障碍和眼病的远程诊断筛查对于老年人在高级生活环境中是否可行和可接受。还测试了改善这一弱势群体获得社区保健服务的可行性。我们期望这项服务在 老年人居住环境的基础上，我们目前的工作，使用类似的策略，以提高糖尿病视网膜病变筛查率在内城初级保健诊所。拟议的非随机可行性研究旨在制定和实施老年生活社区的远程眼科监测计划（目标1）;通过焦点小组和定性工作人员和领导层访谈，确定远程眼科模型在居民和设施层面的可行性和可接受性，了解对设施工作流程和资源的影响（目标2）;并获得四个主要结果的初步估计：（a）通过前后多项选择测试评估居民对眼睛健康的认识（B）居民照顾眼睛健康的动机，以及（c）糖尿病居民报告至少每年一次通过直接询问（d）由眼部成像的筛选值和PI审查确定的老年住宅环境中的视力损害和眼部病理学水平。(Aim 3）我们的老年人远程护理模式有潜力提供以患者为中心的及时有效的护理，减少视力问题对社会造成的财务影响和经济负担。'

DESCRIPTION (provided by applicant): Eye disease and vision impairment are more prevalent in the aged population, especially those in senior living communities, such as assisted or independent living. Older patients with visual impairment are more likely to have severe problems with daily activities, mobility, pain, and discomfort, anxiety, depression, and self-care. By 2030, 50% of seniors will have at least one visually significant ocular disease that could account for about 50% of the health care budget for older adults. Medicare expenses for non-vision-related medical care are 50% higher for those with vision loss than for those without. Fortunately vision loss from the majority of age-related eye conditions can be treated and/or avoided with appropriate preventive measures -- especially if detected early. Thus, there is both a quality of life and cost-advantage to early detection of eye disease among seniors. However, at best, only 60% of the insured Medicare population has regular eye exams. The purpose of this study is to determine whether providing remote diagnostic screenings for vision impairment and eye disease using retinal cameras combined with personalized patient education is feasible and acceptable for older adults in senior living settings. Feasibility of improving access to visio care in this vulnerable population is tested as well. We expect this service to be well received in older adult residential settings based on our current work in using a similar strategy to improve diabetic retinopathy screening rates in inner city primary care clinics. The proposed non-randomized feasibility study aims to develop and implement a teleophthalmology surveillance program in senior living communities (Aim 1); establish feasibility and acceptability of the teleophthalmology model at both the resident and facility level through focus groups and qualitative staff and leadership interviews about impact on facility work flow and resources (Aim 2); and obtain preliminary estimates in four major outcomes: (a) residents' knowledge about eye health assessed by a pre and post multiple choice test (b) residents' motivation to take care of their eye health, and (c) diabetic residents reported intention to see the eye doctor at least annually assessed by directly questioning the , (d) level of vision impairment and eye pathology in an elder residential setting as identified by the screening values and PI review of ocular imaging. (Aim 3) Our Tele-I-CARE for Seniors model has the potential to 'produce patient- centered, timely and effective care that reduces the financial impact and economic burden to society caused by vision problems.'