title: Improving diabetic retinopathy screening ratios using telemedicine-based digital retinal imaging technology: the Vine Hill study.
abstract: OBJECTIVE
  To evaluate the impact of a telemedicine, digital retinal imaging strategy on diabetic retinopathy screening rates in an inner-city primary care clinic.
  
  
  METHODS
  This retrospective cohort study included all diabetic patients aged > or = 18 years (n = 495) seen at Vine Hill Community Clinic between 1 September 2003 and 31 August 2004. Patients were offered ophthalmology referral or digital screening. Patients choosing referral received the next available (within 3 months) appointment at the Vanderbilt Eye Clinic; patients choosing digital screening were screened during the visit.
  
  
  RESULTS
  Retinal screening was documented for 293 (59.2%) patients, a significant improvement compared with the 23% baseline rate. Of 293 patients screened, 92 (31.4%) were screened in ophthalmology, and 201 (68.6%) were digitally screened. Among the 201 digitally screened patients, 104 (51.7%) screened negative and were advised to rescreen in 1 year, 75 (37.3%) screened positive and were nonurgently referred to ophthalmology, and 22 (11.0%) screened positive for sight-threatening eye disease and were urgently referred for ophthalmological follow-up. Digital imaging technical failure rate was 0.5%. Referral status was associated with race/ethnicity (chi2 = 7.9, P < 0.02) with whites more likely to screen negative than non-whites (62.4 vs. 47.8%, respectively). Sight-threatening disease among non-whites (14.7%) was more than double that observed for whites (5.9%).
  
  
  CONCLUSIONS
  Digital imaging technology in the primary care visit can significantly improve screening rates over conventional methods, increase access to recommended diabetic eye care, and focus specialty care on medically indigent patients with greatest need.
authors.affiliation: Vanderbilt University School of Nursing, 461 21st Ave. South, 316 Godchaux Hall, Nashville, TN 37240, USA. cathy.taylor@vanderbilt.edu
authors.forename: Cathy R
authors.initials: CR
authors.lastname: Taylor
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Merin
authors.forename: Amy M
authors.initials: AM
authors.lastname: Salunga
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hepworth
authors.forename: Terri D
authors.initials: TD
authors.lastname: Crutcher
authors.forename: Denis M
authors.initials: DM
authors.lastname: O'Day
authors.forename: Bonita A
authors.initials: BA
authors.lastname: Pilon
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D015331:Cohort Studies; D003930:Diabetic Retinopathy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010781:Photography / Q000379:methods; D012017:Referral and Consultation; D012160:Retina / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017216:Telemedicine; D044465:White People