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

项目摘要/摘要 我们对患有糖尿病视网膜病变(DR)的人群的理解存在几个差距 以及如何最好地管理医生的高危人群这些差距的持续存在是 难以实现拟议研究方案的长期目标：减少可预防的失明 这项建议的总体目标是为高危人群设计一种患者导航仪干预。 对于通过对未诊断医生的全国性分析而获得信息的DR，中心假设是候选人可以 创建一个可行且可接受的计划，以提高对医生高危人群的眼部护理的利用率 这一假设的基本原理是，让糖尿病高危患者参与眼部筛查将有助于更早地 治疗糖尿病视网膜病变，减少可预防的失明。该提案的特点是采用多种方法来 确定未诊断的DR的患病率以及个人和社区水平的特征，以及 针对DR高危人群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)有重点地确定全国未确诊DR的患病率 关于种族和民族差异和地理空间差异；以及2)设计和试行患者导航器计划 对于第一个目标，具有代表性的美国人口样本将使用以下方法进行评估 2005-2008年全国健康和营养检查调查。接受眼底检查的参与者 基于软件辅助图像分级的摄影和被诊断为DR的人将被包括在 分析。那些在家庭访谈中报告之前被诊断为糖尿病视网膜病变的人将与那些报告的人进行比较 没有报告医生的诊断结果，目标二，针对慢性病的定制实施 科学框架将指导该计划的设计。首先，我们将进行半结构化采访， 1年内未进行眼科检查的当地社区糖尿病患者。第二，决定因素 在面谈期间和第一个目标中确定的目标将适用于该框架。第三，决定因素是 一个由利益相关者组成的多学科团队将优先设计该计划。第四，60名参与者将 从糖尿病患者中招募，根据眼部护理利用情况和风险进行分层，数据来自 机构电子病历。该计划将包括个人患者导航器评估， 临床评估、教育体验和患者导航员随访。这种方法是创新的。 因为它识别出患有未诊断的DR的人群，所以使用风险计算器来识别高危人群 DR，并使用基于患者导航器的程序来改进对DR高危人群的筛查 这项研究意义重大，因为它调查了已公布的指南与 尽管有完善的筛查建议，但仍继续失明。阮燕武博士的短期目标 是发展实施科学方面的专业知识，以解决糖尿病眼科护理中的健康差距。她所受的训练 该计划通过课程学习和独立学习来支持她近期的培训目标。

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.