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Teleretinal Screening for Diabetic Retinopathy
A Novel Approach to Reduce Screening Burden on the
Healthcare Systems within Central Texas
Austin, Texas April 6, 2017
Robert W. Wong, MD Assistant Clinical Professor, Dell Medical School
Austin Retina Associates, Austin, TX
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3835
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200 Amputations
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136 Develop Kidney Disease
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1795 Severe Diabetic Retinopathy
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Diabetes
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Leading Cause of Blindness in younger patients in the US
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ADA Guidelines
Type 1: Annual screenings within 5 years of onset
Type 2: Annual screenings immediately following diagnosis
Then, yearly follow up exams.
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PAINPOINT Patients don’t get screened
In Travis County
25% made appointments
After vigorous calling, still only 50% made appointments
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Stakeholder: Patient
Burden to the patient
Travel
Time off work
Cost
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Stakeholder: Doctors
Burden to the Doctor
Primary Care Doctor Needs
Unused appointment slot in Specialists office
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Stakeholder: Healthcare System
Cost Burden to the Healthcare System
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Elements of Disruptive Innovation
Clayton Christensen. The Innovator’s Prescription. 2009.
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Solution: Teleretinal Screening
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How Diabetic Teleretinal Screening Works
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Our Study
Austin Regional Clinic
5 Locations
3620 diabetics screened
12 month period
99% had insurance
Private practice patients
CommUnity Care / Central Health
2 locations
1830 diabetics screened
6 month period
Uninsured or underinsured
Safety net population
1. Prevalence and Severity of Diabetic Retinopathy
2. Prevalence of Diabetic Macular Edema
3. Capture Rate: % of patients with pathology that attended appointment
with retinal specialist
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Overall Prevalence in Travis County
5450 patients screened
Total Prevalence of Retinopathy 22.7%
Total Prevalence of Macular Edema 6.3%
Patients requiring Urgent Referral 11.8%
Capture Rate 65.0%
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Reduced Burden
1558 CommUnity Care patients (85.1%) did not require further evaluation by a retinal specialist
3249 ARC patients (89.9%) did not require further evaluation by a retinal specialist
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Those that needed to come in… we got in
Capture Rate at CC was 65.4%
Capture Rate at ARC was 65.5%
Previous reports in literature ~30%
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Retinopathy and Macular Edema were higher in CommUnity Care patients than Austin Regional Clinic
DR: 26.6% versus 20.7% p < 0.0002
DME: 8.6% vs 5.1% p < 0.0002
Differences?
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Does Geography make a difference?
CommUnity Care
Southeast Location had worse retinopathy than North-Central
DR: 28.9% versus 24.0%
DME: 10.1% versus 6.9%
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Hwy 183 Corridor
Ben White Blvd Corridor
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Future Directions
Better understand demographic data and biomarkers to account for differences
Collaborate with Seton Medical Center
Collaborate with Intelligent Retinal Imaging Systems to create a nationwide map of diabetic retinopathy
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Make information available to Stakeholders
Patients
Physicians
Epidemiologists
Government
Industry
Tech
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Special Thanks
Maria Benson, BS
Jose A. Martinez, MD
C. Armitage Harper, MD
James W. Dooner, MD
Mark Levitan, MD
Peter A. Nixon, MD
Shelley Day-Ghafoori, MD
Stephanie Collins, MBA
Anas Dhagastani, MD
Austin Regional Clinic
Mark S. Hernandez, MD
Jonathan Morgan
Central Health / CommUnity Care
Jason Crawford
Intelligent Retinal Imaging Systems
@drwongsays
Blog: www.36thandhamilton.com