Using telemedicine to improve glaucoma care: An emerging eye care delivery model

 描述(由申请人提供)：本申请提出了一项培训计划，旨在将医学博士Lindsay A.Rhodes发展成为一名独立的临床医生和科学家，专门从事医疗服务研究，包括远程医疗等新型护理提供模式。罗兹博士是一名董事会认证的眼科医生，接受过青光眼专科培训，并具有远程医疗方面的研究经验。这一培训计划将包括有指导的研究，高级课程工作，导致公共卫生结果研究的科学硕士学位，以及多学科会议。指导研究将在以下指导团队的指导下进行：UAB眼科主任教授Christopher Girkin博士、UAB眼科教授兼临床研究副主席Cynthia Owsley博士、UAB医疗保健组织和政策部教授Stephen Mennomeyer博士以及UAB流行病学系教授兼副主席Gerald McGwin博士。建议的指导性研究计划将评估一种新的基于社区的开角型青光眼护理提供模式。最重要的假设是，基于远程医疗的检测和管理计划使用在社区诊所进行的全面远程视神经评估(Crona)，然后传输到远程阅读中心，可以与青光眼专家的标准面对面护理一样准确地接触到高危少数群体，成本更低，并有一个旨在提高患者对青光眼药物服药依从性的眼睛健康教育平台。这一假设将利用阿拉巴马大学伯明翰分校最近开发的远程医疗演示计划获得的数据进行验证，该计划题为《社区眼科护理质量和可获得性改善(EQUAL)》，同时还将进行一项较小规模的横断面研究。Equity在两家初级眼科护理诊所(沃尔玛视力中心)内部署了综合远程医疗计划，这些诊所位于零售中心内，主要服务于阿拉巴马州服务不足地区的非裔美国人社区。在这些以零售为基础的诊所中，初级眼科保健提供者进行扩大的全面眼科检查，并额外使用自动化的视神经结构和功能评估，以帮助检测青光眼。然后，综合眼科检查和视神经评估的数据被电子传输到地理位置远离初级眼科保健诊所的三级青光眼中心，在那里由接受过青光眼团契培训的眼科医生进行评估。本申请中提出的培训和有指导的研究计划将使罗兹博士能够实现她的目标，即成为一名独立的临床医生和科学家，能够为创造新的护理提供方法做出有意义的贡献，以满足我们日益增长的卫生保健需求。

 DESCRIPTION (provided by applicant): This application proposes a training plan to develop Lindsay A. Rhodes, MD into an independent clinician- scientist specializing in health services research, including novel care delivery models such as telemedicine. Dr. Rhodes is a board certified ophthalmologist with subspecialty training in glaucoma and with prior research experience in telemedicine. This training program will consist of mentored research, advanced coursework leading to a Master of Science in Public Health in Outcomes Research, and multi-disciplinary conferences. Mentored research will be conducted under the direction of a mentoring team composed of Dr. Christopher Girkin, Professor and Chairman of the UAB Department of Ophthalmology, Dr. Cynthia Owsley, Professor and Vice Chair for Clinical Research at the UAB Department of Ophthalmology, Dr. Stephen Mennemeyer, Professor in the UAB Department of Health Care Organization and Policy, and Dr. Gerald McGwin, Professor and Vice Chair in the UAB Department of Epidemiology. The proposed mentored research plan will evaluate a novel community-based care delivery model for open angle glaucoma. The overarching hypothesis is that a telemedicine-based detection and management program using a comprehensive remote optic nerve assessment (CRONA) performed in community clinics and then transmitted to a remote reading center can access at-risk minority populations as accurately as standard in-person care by a glaucoma specialist, at lower cost, and with a platform for eye health education designed to improve patient adherence to filling glaucoma medications. This hypothesis will be tested utilizing data obtained from a recently developed telemedicine demonstration program at the University of Alabama at Birmingham, entitled Eye Care Quality and Accessibility Improvement in the Community (EQUALITY), along with a smaller cross-sectional study. EQUALITY deployed an integrated telemedicine program within two primary eye care clinics (Walmart Vision Centers) located within retail centers that serve predominantly African American communities in underserved areas of Alabama. Primary eye care providers in these retail-based clinics performed dilated comprehensive eye exams with the additional use of automated optic nerve structural and functional assessment to assist in the detection of glaucoma. The data from the comprehensive eye exam and optic nerve assessment was then transmitted electronically to a tertiary glaucoma center, located geographically remotely from the primary eye care clinics, where it was evaluated by an ophthalmologist with fellowship training in glaucoma. The training and mentored research program proposed in this application will enable Dr. Rhodes to achieve her goal of becoming an independent clinician-scientist who can meaningfully contribute to the creation of novel care delivery methods to address our growing health care needs.