Quality improvement project to improving diabetic retinopathy screening in a primary care provider's practice

Abstract

BACKGROUND: Diabetic retinopathy (DR) continues to be the leading cause of blindness among the working-age population. The aim of this study was to improve DR screening (DRS) rates within primary care through the implementation of a patient questionnaire and follow-up intervention. The study was conducted at a rural primary care provider's office. METHODS: SEIPS 3.0 model was used specifically, and the journey map was applied during diabetes office visits to assess processes and influences impacting DRS. An intervention supported by current evidence was created to address identified barriers to screening. INTERVENTION: The project lead and healthcare providers collaboratively created a DRS questionnaire and new process (i.e., record and fax) to be implemented during every diabetic mellitus follow-up visit. RESULTS: Of the 17 patients with diabetes, 15 (88%) received the DRS paperwork. Three (20%) had not completed their DRS, and 12 had. 11 of the 12 had current ophthalmology notes and the EMR was updated. Request of information (ROI) was faxed to ophthalmologists for the patients who did not have a current DRS note or had not completed DRS. Two ROIs were returned with DRS date. During the project, 87% of patients evaluated had their DRS date entered into the EMR, and office-wide there was a 13% increase in total DRS rates. CONCLUSIONS: Action to address low DRS rates needs to address the multifaceted barriers that make standardizing DRS difficult. This project led to improvements in DRS rates, but the site eluded to not continue the new process. Prolonged interactions may identify barriers to sustaining the new process.