title: Evaluating Adherence to Dilated Eye Examination Recommendations Among Patients with Diabetes, Combined with Patient and Provider Perspectives.
abstract: BACKGROUND
  Diabetes mellitus remains the leading cause of new cases of blindness among US adults. Routine dilated eye examinations can facilitate early detection and intervention for diabetes-related eye disease, providing an opportunity to reduce the risk for diabetes-related blindness in working-aged Americans. The Healthcare Effectiveness Data and Information Set (HEDIS) established criteria for performing dilated eye examination in patients with diabetes.
  
  
  OBJECTIVE
  To obtain information about adherence and nonadherence to diabetic eye examinations among insured patients to understand the barriers to routine dilated eye examinations, and to identify ways to improve the quality of care for these patients.
  
  
  METHODS
  This retrospective claims analysis is based on administrative claims from the HealthCore Integrated Research Database, a broad database representing claims from a large commercially insured population. Patients with diabetes and who had ≥1 dilated eye examinations between August 1, 2011, and July 31, 2013, were defined as adherent to the HEDIS recommendations. The analysis was augmented with findings from focus groups. The patient focus groups included adherent and nonadherent patients. The provider focus group participants were general practice or internal medicine physicians and ophthalmologists who provided medical care for the study population. For the administrative claims analysis, comparisons between the adherent and nonadherent patients were performed usingt-tests for continuous data and chi-square tests for categorical data.
  
  
  RESULTS
  Of 339,646 patients with diabetes identified in a claims data set, 43% were adherent and 57% were nonadherent to the HEDIS eye examination performance measure. The common barriers to routine eye examination cited by 29 patients across 4 focus groups included a lack of understanding of insurance benefits (N = 15), a lack of awareness of the importance of dilated eye examinations (N = 12), and time constraints (N = 12). The common barriers cited by 18 providers included the patient's level of education (N = 13), eye examinations as a lower priority than the management of other diabetes-related health issues (N = 12), and a lack of symptoms (N = 11).
  
  
  CONCLUSIONS
  Several reasons for patient nonadherence to routine eye examination were identified, including a lack of understanding of insurance benefits, a lack of awareness or low prioritization of having an examination, patient education level, time constraints, and a lack of symptoms. These may be considered by providers and payers when developing programs to increase the rates of eye examinations and improve outcomes among patients with diabetes.
authors.affiliation: Director, Real World Evidence, Vector Oncology, Memphis, TN, and was with HealthCore at the time of the study.
authors.forename: Maxine D
authors.initials: MD
authors.lastname: Fisher
authors.affiliation: Senior Health Economist, Genentech, South San Francisco, CA.
authors.forename: Yamina
authors.initials: Y
authors.lastname: Rajput
authors.affiliation: Senior Researcher, HealthCore, Wilmington, DE.
authors.forename: Tao
authors.initials: T
authors.lastname: Gu
authors.affiliation: Chief Medical Officer, HealthCore.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Singer
authors.affiliation: Director, Research Data Collection, HealthCore.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Marshall
authors.affiliation: Managed Care Liaison, Genentech.
authors.forename: Seonyoung
authors.initials: S
authors.lastname: Ryu
authors.affiliation: Clinical Pharmacy Scientist, HealthCore.
authors.forename: John
authors.initials: J
authors.lastname: Barron
authors.affiliation: Chief Medical Value Officer, Hospital for Special Surgery, New York, NY, and was with Anthem at the time of the study.
authors.forename: Catherine
authors.initials: C
authors.lastname: MacLean
keywords: HEDIS measures; adherence; diabetes mellitus; dilated eye examination; nonadherence; ophthalmologists; primary care physicians