Undiagnosed Diabetic Retinopathy: Using Participatory Science to Design an Intervention for Patients at High-Risk for Blindness

项目总结/摘要 我们对糖尿病视网膜病变（DR）患者的理解存在一些差距， 筛选，以及如何最好地管理那些高风险的DR。这些差距的持续存在， 解决拟议研究计划的长期目标的困难：减少可预防的失明 该提案的总体目标是为高风险患者设计患者导航干预 通过对未确诊的DR的全国性分析来了解DR。中心假设是候选人可以 创建一个可行和可接受的计划，以增加DR高风险人群对眼部护理的利用。 该假设的基本原理是，让糖尿病高危患者参与眼部筛查将有助于早期 减少可预防性失明。该提案采用多方法方法， 确定未确诊DR的患病率以及个体和社区水平特征， 针对DR高风险患者的患者导航计划试点研究。候选人将达到总体目标 通过追求以下两个具体目标：1）确定国家未诊断DR的患病率，重点是 种族和民族差异和地理空间变化; 2）设计和试点病人导航程序， 对于第一个目标，美国人群的代表性样本将使用 2005 - 2008年全国健康和营养检查调查。接受眼底检查的受试者 摄影并根据软件辅助图像分级诊断为DR的患者将被纳入 分析.那些在家庭访谈中报告先前诊断为DR的人将与那些报告DR的人进行比较。 不报告DR的诊断。对于目标二，慢性病定制实施 科学框架将为方案的设计提供信息。首先，我们将进行半结构化面试， 患有糖尿病的当地社区成员在1年内没有进行过眼科检查。第二，决定因素 在访谈期间和第一个目标中确定的目标将适用于该框架。第三，决定因素将是 一个由利益攸关方组成的多学科小组将设计该方案。第四，60名与会者将 从糖尿病人群中招募，根据眼科护理使用和风险分层， 机构电子病历。该计划将包括一个单独的病人导航评估， 临床评估、教育体验和患者导航员随访。这种做法是创新的 因为它识别了未诊断的DR人群，使用风险计算器来识别那些处于高风险的人， DR，并采用基于患者导航器的程序来改善对DR高风险人群的筛查。 这项研究意义重大，因为它调查了已发表的指南和人群之间的差距， 尽管有明确的筛查建议，但仍继续失明。Nwanyanwu博士的短期目标 是发展实施科学的专业知识，以解决糖尿病眼科护理中的健康差异。她的训练 该计划通过课程和独立学习支持她的直接培训目标。

Project Summary/Abstract There are several gaps in our understanding of the population with diabetic retinopathy (DR) that is not being screened and how best to manage those at high-risk for DR. Continued existence of these gaps underlies the difficulty in addressing the long-term goal of the proposed research program: to decrease preventable blindness from DR. The overall objective of this proposal is to design a patient navigator intervention for those at high-risk for DR informed by a national analysis of undiagnosed DR. The central hypothesis is that the candidate can create a feasible and acceptable program to increase utilization of eye care in those at high-risk for DR. The rationale for the hypothesis is that engaging high-risk patients with diabetes in eye screening will facilitate earlier treatment of DR and decrease preventable blindness. The proposal features a multi-method approach to determine the prevalence and the individual and neighborhood level characteristics of undiagnosed DR, and a patient navigation program pilot study for those at high-risk for DR. The candidate will reach the overall objective by pursuing the following two specific aims: 1) Determine national prevalence of undiagnosed DR with a focus on racial and ethnic disparities and geospatial variation; and 2) design and pilot a patient navigator program for those at high-risk for DR. For the first aim, a representative sample of the US population will be evaluated using the National Health and Nutrition Examination Survey, 2005-2008. Participants who underwent fundus photography and were diagnosed with DR based on software-assisted image grading will be included in the analysis. Those who reported a prior diagnosis of DR in an in-home interview will be compared to those that did not report a diagnosis of DR. For aim two, the Tailored Implementation for Chronic Disease implementation science framework will inform the design of the program. First, we will conduct semi-structured interviews with local community members with diabetes who have not had an eye exam within 1 year. Second, the determinants identified during the interviews and in the first aim will be applied to the framework. Third, determinants will be prioritized and a multidisciplinary team of stakeholders will design of the program. Fourth, sixty participants will be recruited from a population with diabetes stratified by eye care utilization and risk based on data from the institutional electronic medical record. The program will include an individual patient navigator assessment, a clinical evaluation, an educational experience, and patient navigator follow-up. This approach is innovative because it identifies the population with undiagnosed DR, uses a risk calculator to identify those at high risk for DR, and employs a patient navigator-based program to improve screening for those at high risk for DR. This study is significant because it investigates the gap between published guidelines and the population that continues to go blind despite well-established recommendations for screening. Dr. Nwanyanwu’s short-term goal is to develop expertise in implementation science to address health disparities in diabetic eye care. Her training program supports her immediate training goals through coursework and independent study.