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部护理的系统层面和个人层面的因素；并确定提供符合防止视力丧失和促进眼睛健康的最佳实践的眼部护理的障碍和推动因素。约翰霍普金斯翻译研究中心(TRC)将分析多个现有数据库，为旨在减少医疗保健差距和改善美国服务不足人群眼睛健康的公共卫生干预开发知识库。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，利用这些知识在城市层面上实施。第一组分析将集中在三个先前被研究的人群中与接受眼部护理服务相关的个人和感知的系统障碍：索尔兹伯里眼睛评估(SEE)研究中的非裔美国人和高加索人，生活在亚利桑那州的拉丁裔(作为Proyecto Ver的一部分进行研究)和巴尔的摩的拉丁裔(在由NIH资助的Provide研究中进行评估)。将在所有三个种族/民族中评估获得白内障手术服务的障碍和促成因素，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口加以解决，并辅之以国家健康和营养检查调查(NHANES)的分析。最后，将使用Medicare筛查福利提供的青光眼筛查比率以及青光眼的比率和治疗模式将使用Medicare的数据进行评估。此外，NHANES同时具有视野和视神经成像，这些数据将被用来确定当青光眼出现时与被诊断为青光眼的相关性，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。根据上述分析的结果，将测试一种提高DR筛查率的干预措施。最后，将进行事前/事后评估，看看干预措施是否可能在全国范围内扩大。

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.