title: Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.
abstract: Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year.
  
  
  
  Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans.
  
  
  
  By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.
authors.affiliation: Atlanta VA Medical Center, Ophthalmology Division, Decatur, Georgia, USA. amaa@emory.edu.
authors.forename: April Y
authors.initials: AY
authors.lastname: Maa
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA. barbara.wojciechowski@va.gov.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wojciechowski
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA. huntk@musc.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: Hunt
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA. clara.dismuke@va.gov.
authors.forename: Clara
authors.initials: C
authors.lastname: Dismuke
authors.affiliation: Atlanta VAMC, Ophthalmology Division, Decatur, Georgia, USA. rabeea.janjua@va.gov.
authors.forename: Rabeea
authors.initials: R
authors.lastname: Janjua
authors.affiliation: Atlanta VAMC, Ophthalmology Division, Decatur, Georgia, USA. mary.lynch4@va.gov.
authors.forename: Mary G
authors.initials: MG
authors.lastname: Lynch
mesh_terms: D005128:Eye Diseases / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D005845:Georgia; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D009885:Ophthalmology / Q000458:organization & administration; D017060:Patient Satisfaction; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D058014:Veterans Health / Q000191:economics / Q000706:statistics & numerical data*
keywords: Medical; North America; Ophthalmology