1. NH-Dartmouth FP Residency, Concord, NH
FP and Ophthalmology Caring to Screen in Diabetes - the FOCuSeD Quality Improvement Project.
Stephen Elgert, MD MS
NH-Dartmouth FP Residency, Concord, NH

2. Goal of Talk
To report on the evolution of a unique partnership developed between Concord Hospital Ophthalmologists and the Family Health Center, the Community Health Center associated with the NH-Dartmouth F.P. Residency.
To provide information so you may duplicate our efforts

3. Context
Diabetic retinopathy - treatable and unfortunately common cause of blindness.
National guidelines - yearly retinal screening by qualified providers

4. Background
Access to ophthalmologic care can be problematic in patients with no insurance or of limited socioeconomic means.
A challenge for Community Health Centers

5. Our Demographics
The clinic: 13,000 active patients, 690 of whom are diabetic.
Approximately 32% of our patient's income is < 200% of the poverty line.
Access to many types of specialists care is often problematic

6. Baseline
Our baseline screening for retinal pathology was less than 20%.
This persisted despite feedback and education to both providers and patients

7. Methods
Analysis of the data suggested there were institutional and financial barriers to improving this rate
Literature review showed that a using a retinal camera in the primary care office can positively improve the rate of screening

8. Methods II
The two largest barriers were the cost of the camera equipment and who would read the photographs
National services were available for a fee
Prior to going “national” we decided to go “local”

9. Methods III
We approached the ten ophthalmologists associated with the Concord Hospital to read our scans
They declined - would not meet their quality standards
After much negotiating, we created a free monthly retinal-screening clinic

10. Methods IV
Each month one of ten local Ophthalmologists would donate 2-4 hours of their time to examine patients in their own offices
We would skip Aug and Dec
Our clinic does the scheduling and supplies social work support on site for each clinic.
The Lion's Club has also helped this effort with funding for critical follow up.

11. Results
Our partnership has increased our retinal-screening rate for our diabetic patients to 37%

13. Results II
We are in our 6th successful month with almost 100 patients screened.

14. Results III

15. Survey of Patients (n= 33)
Patient satisfaction has been very high (4.67 out of 5 max)
97% thought visit met expectations
24% were unaware of the ADA standard for yearly eye exam in diabetes
7% had transportation problems
For 33% - this was their first eye exam

16. Conclusions:
By partnering with our local ophthalmologists we have statistically significantly changed our system of care for a parameter that was difficult to improve in the past
Done without grant funding
You can do it too!

17. Future Challenges:
Finding ways to treat eye pathology in patients who have no resources – one possibility:
eyecareamerica.org/eyecare/public/helplines.cfm
No shows – 24%
Scheduling issues
Attitudinal barriers

18. Thanks to our team: Geny Laroche Jane Sanborn Jean Anglim
Megan Mischke