title: Operational challenges in delivery of a charity care program for diabetic retinopathy screening in an urban setting.
abstract: BACKGROUND
  The University of Chicago Medicine (UCM) partners with Chicago Family Health Center (Chicago Family) in the Diabetic Retinopathy Screening Program (DRP), a charity care program to screen uninsured and underinsured patients with diabetes for diabetic retinopathy, which is a leading cause of preventable vision loss in the US. The DRP faced operational challenges throughout its pilot year: a high number of ungradable retinal images, slow turnaround time for reading retinal images and sending results, incomplete referrals, and a high rate of no-shows for diagnostic appointments.
  
  
  METHODS
  Chicago Family recalled patients with ungradable images for repeat imaging, and regular training was provided to staff taking the images. Weekly e-mails were sent to the physician champion reminding him to read images, and image software was installed on his laptop. Patients received reminder cards and preappointment and postappointment phone call reminders, and appointment information was shared with referring physicians. The UCM clinic was double-booked, so patients were seen within four weeks of referral. Discussions were held with UCM/Chicago Family teams to stress the influence of timely referrals on no-show rate; reminders were sent to referring physicians for referrals.
  
  
  RESULTS
  Complete referrals were received within five days; the overall number of ungradable images decreased; image report turnaround time continued to be a challenge because of difficulties related to physician availability and technology; show rates began to increase.
  
  
  CONCLUSIONS
  The methods of this intervention will translate well to other programs that provide care for similar patient populations in urban areas.
authors.affiliation: Strategic Affiliations for the Urban Health Initiative at the University of Chicago Medicine, USA. erica.eckhardt@uchospitals.edu
authors.forename: Erica H
authors.initials: EH
authors.lastname: Chedid
authors.forename: Quin R
authors.initials: QR
authors.lastname: Golden
authors.forename: Rama D
authors.initials: RD
authors.lastname: Jager
mesh_terms: D000328:Adult; D002608:Charities; D002641:Chicago; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D017057:Medically Uninsured; D008875:Middle Aged; D010865:Pilot Projects; D015397:Program Evaluation; D014505:Urban Population; D055815:Young Adult