| Abstrakt: |
IMPORTANCE Telemedicine is a useful clinical method to extend health care to patients w ith limited access. Minimal information exists on the subsequent effect of telemedicine activities on eye care resources. OBJECTIVE To evaluate the effect o f a community-based diabetic teleretinal screening program on eye care use and resources. DESIGN, SETTING. AND PARTICIPANTS The current study was a retrospective medical record review o f patients who underwent diabetic teleretinal screening in the community-based clinics o f the Atlanta Veterans Affairs Medical Center from October 1,2008, through March 31, 2009, and who were referred for an ophthalmic examination in the eye clinic. EXPOSURES Clinical medical records were reviewed for a 2-year period after patients were referred from teleretinal screening. The following information was collected for analysis: patient demographics, referral and confirmatory Telemedicine is increasingly used for disease monitoring and management o f chronic medical and mental disorders, but also has screening and diagnostic applications such as teleradiology and teledermatology. Indeed, "therapy at a distance" will complement office-based care in the 21st century. Another screening application is teleophthalmology, in which digital photography w ith telemedicine links has proven cost-effective for retinal disorders, including diabetic retinopathy and retinopathy o f prematurity.1'2 In a recent study in JAMA Ophthalmology, Chasan et al3 complemented prior cost-effectiveness analyses of teleretinal screening programs by examining both the accuracy of diabeticteleretinal screening as well as the subsequent eye care use and resources required in such a program. Regarding accuracy, screening tests that have good sensitivity and specificity are likely to be more cost-effective. Regarding resource use, im plementation of screening generates more referrals, testing, and procedures. The cost-effectiveness of any screening program is therefore contingent on reasonable test accuracy coupled w ith a sufficient supply o f resources to meet the increased demand. diagnoses, ophthalmology clinic visits, diagnostic procedures, surgical procedures, medications, and spectacle prescriptions. MAIN OUTCOMES AND MEASURES The accuracy between referring and final diagnoses and the eye care resources that were used in the care o f referred patients. RESULTS The most common referral diagnoses were nonmacular diabetic retinopathy (43.2%), nerve-related disease (30.8% ), lens or media opacity (19.1%), age-related macular degeneration (12.9%), and diabetic macular edema (5.6%). The percentage o f agreement among these 5 visually significant diagnoses was 90.4%, w ith a total sensitivity of 73.6%. Diabetic macular edema required the greatest number o f ophthalmology clinic visits, diagnostic tests, and surgical procedures. Using Medicare cost data estimates, the mean cost incurred during a 2-year period per patient seen in the eye clinic was approximately $1000. CONCLUSIONS AND RELEVANCE Although a teleretinal screening program can be accurate and sensitive for multiple visually significant diagnoses, measurable resource burdens should be anticipated to adequately prepare for the associated increase in clinical care. [ABSTRACT FROM AUTHOR] |
