Johns Hopkins Healthy Eyes Translational Research Center

描述（由申请人提供）：本合作协议的重点是评估和评估影响获得眼科护理的系统层面和个人层面因素；并确定障碍和促进提供符合最佳做法的眼睛保健，以防止视力丧失和促进眼睛健康。约翰霍普金斯转化研究中心（TRC）将分析多个现有数据库，为公共卫生干预开发一个知识库，旨在减少医疗保健差距，改善美国服务不足人群的眼睛健康。具体来说，我们将重点关注白内障、青光眼和糖尿病视网膜病变。最后，我们提出了一项合作研究，将这些知识用于城市层面的实施。第一组分析将集中在三个先前研究人群中与接受眼科保健服务相关的个人和感知系统障碍：来自索尔兹伯里眼科评估（SEE）研究的非洲裔美国人和高加索人，生活在亚利桑那州的拉丁美洲人（作为proyeto Ver的一部分研究）和生活在巴尔的摩的拉丁美洲人（在由NIH资助的ProVision研究中评估）。将在所有三个种族/民族群体中评估获得白内障手术服务的障碍和促进因素，而与糖尿病视网膜病变筛查相关的因素将通过两个拉丁裔人群来解决，并补充分析国家健康和营养检查调查（NHANES）。最后，使用医疗保险筛查福利提供的青光眼筛查率以及青光眼治疗的比率和模式将使用医疗保险的数据进行评估。此外，NHANES同时具有视野和视神经成像，这些数据将用于确定已诊断为青光眼的人群是否存在青光眼，以便识别诊断不足的高风险人群。拟议的TRC网络联合项目将包括与市政府合作建立糖尿病视网膜病变（DR）筛查监测系统，以便能够监测护理模式，特别是在服务不足的高危人群中。根据上述分析结果，将测试一种干预措施，以提高DR筛查率。最后，将进行事前/事后评估，以确定是否可以在全国范围内扩大干预。

DESCRIPTION (provided by applicant): The focus of this cooperative agreement is to assess and evaluate system level and individual level factors that impact access to eye care; and to identify barriers and enablers to the delivery of eye care conforming to best practices that prevent vision loss and promote eye health. The Johns Hopkins Translational Research Center (TRC) will analyze multiple existing databases to develop a knowledge base for a public health interventions aimed at reducing healthcare disparities and improving the eye health of underserved populations in the United States. Specifically, we will focus on focus on cataract, glaucoma, and diabetic retinopathy. Finally, we propose a collaborative study that uses this knowledge for implementation at the city level. The first set of analyses will focus on personal and perceived system barriers associated with the uptake of eyecare services in three previously studied populations: African Americans and Caucasians from the Salisbury Eye Evaluation (SEE) study and Latinos living in Arizona (studied as part of Proyecto Ver) and Latinos living in Baltimore (evaluated in the ProVision study funded by the NIH). The barriers and enablers of obtaining cataract surgical services will be assessed in all three racial/ethnic groups, whereas factors related to screening for diabetic retinopathy will be addressed using the two Latino populations, supplemented with analyses of the National Health and Nutrition Examination Surveys (NHANES). Finally, the rates of glaucoma screening provided using the Medicare screening benefit as well as the rates and patterns of treatment of glaucoma will be assessed using data from Medicare. Additionally, NHANES has both visual field and optic nerve imaging and these data will be used to determine associations with having been diagnosed with glaucoma when it is present in order to identify groups at high risk for underdiagnosis. The proposed TRC network combined project will consist of establishing diabetic retinopathy (DR) screening surveillance systems in collaboration with city governments to be able to monitor patterns of care, especially among at risk underserved populations. An intervention will be tested to increase DR screening rates based on the findings of the analyses described above. Finally, a pre/post assessment will be made to see if the intervention might be expanded nationally.