I-TRUST: Implementation of Teleophthalmology in Rural Health Systems Study

项目总结/摘要 在工作年龄的美国成年人中，糖尿病视网膜病变仍然是失明的主要原因，尽管 具有里程碑意义的国家眼科研究所（NEI）的临床试验表明，早期发现和治疗可以降低 严重的视力丧失超过90%。然而，在美国，每年坚持进行糖尿病视网膜病变筛查的情况仍然存在。 农村地区的患者不到一半。眼科远程医疗（即远程眼科学）可以基本上 提高糖尿病视网膜病变筛查率，预防失明。然而，通常使用非常有限。 即使在多付款人医疗系统中建立了远程眼科学项目之后， 大多数美国人都得到了他们的照顾。克服在农村地区使用远程眼科的主要障碍 多付款人初级保健诊所，PI开发和试点实施，以维持影响， 远程眼科学（I-SITE）获得NEI K23职业发展奖。I-SITE是第一个实施方案 通过将远程眼科纳入农村初级教育， 护理诊所工作流程。本研究是一项多中心随机对照试验，旨在：（1）检测 （2）确定解释性因素和执行组成部分，区分高 I-SITE实施后，远程眼科学在农村卫生系统中的使用率较低，以及（3）评估 执行费用。我们假设I-SITE将维持显著的糖尿病眼筛查率增加 与常规远程眼科治疗相比， 该UG 1提案直接响应NEI战略计划的多个要素，包括以下领域 重点是远程医疗、糖尿病视网膜病变和扩大农村人口获得眼科护理的机会。这 研究将促进远程医疗技术在农村多支付者初级保健诊所的有效转化 提高糖尿病视网膜病变筛查率。眼科远程医疗的有效整合和规模扩大 将极大地扩大数百万美国农村地区的眼科保健服务。这对于防止可避免的 通过克服眼科护理提供者的短缺和满足对眼睛的需求增加， 由于糖尿病患病率预计将大幅增加而导致的筛查。当我们面对 我们国家的卫生系统面临前所未有的挑战，在我们的历史上从来没有需要一个 向远程保健的快速过渡更为紧迫。我们的研究将提供有关 成功地将远程保健技术转化为广泛的临床应用所需的方法和因素 在全国范围内改善公共卫生的做法。

PROJECT SUMMARY/ABSTRACT Among working-age U.S. adults, diabetic retinopathy remains the leading cause of blindness despite landmark National Eye Institute (NEI) clinical trials showing that early detection and treatment reduce the risk of severe vision loss by over 90%. Yet adherence with yearly diabetic retinopathy screening in the U.S remains below half of patients in rural communities. Ocular telemedicine (i.e. teleophthalmology) can substantially increase diabetic retinopathy screening rates and prevent blindness. However, there is often very limited use of this technology even after a teleophthalmology program is established in multi-payer health systems, where the majority of Americans receive their care. To overcome major barriers identified for teleophthalmology use in rural multi-payer primary care clinics, the PI developed and piloted Implementation to Sustain Impact in Teleophthalmology (I-SITE) in a NEI K23 Career Development Award. I-SITE is the first implementation program specifically designed to overcome barriers to teleophthalmology use by tailoring its integration into rural primary care clinic workflows. The proposed study is a multi-center randomized controlled trial aiming to: (1) test the effectiveness of I-SITE, (2) identify explanatory factors and implementation components that distinguish high and low teleophthalmology use in rural health systems following I-SITE implementation, and (3) evaluate implementation costs. We hypothesize that I-SITE will sustain significant diabetic eye screening rate increases at 18 months compared to usual care teleophthalmology. This UG1 proposal directly responds to multiple elements of the NEI Strategic Plan, including areas of emphasis in telemedicine, diabetic retinopathy, and expanding access to eye care in rural populations. This research will facilitate the effective translation of telemedicine technology in rural multi-payer primary care clinics to improve diabetic retinopathy screening rates. The effective integration and scale-up of ocular telemedicine would greatly expand eye care access for millions of rural Americans. This will be critical for preventing avoidable blindness by overcoming the shortage of eye care providers and meeting the increased demand for eye screening resulting from major projected increases in diabetes prevalence. As we face unprecedented challenges to our nation's health systems, never before in our history has the need for a rapid transition to telehealth been more acute. Our study will provide vital knowledge regarding the methods and factors needed to successfully translate telehealth technology into widespread clinical practice for improving public health nationwide.