Evaluation of the efficacy of teleophthalmology in timely specialty referral of a high-risk underserved population within public private partnership, in population, of the Los Angeles County health system.

摘要

Diabetic retinopathy (DR), retinal or eye disorder caused by diabetes, is the leading cause of blindness among working adults and therefore presents a public-health and policy concern. The research described here is an empirical study that evaluated the effectiveness of the implementation of teleophthalmology, a form or telemedicine or telehealth, in shortening the referral appointment timeframe and increasing clinically recommended annual eye-screening appointment rates for DR. As part of the evaluation, digital image quality measures that could assist in evaluating digital processes were introduced.; Data were obtained retrospectively from clinics that are part of the Los Angeles County Public-Private Partnership (PPP) Program. The clinics are in a consortium for the DR teleophthalmology screening project, but they are not integrated. The clinics serve a high-risk population and mostly uninsured or underinsured population. Overall, 654 records that included clinical outcomes and teleophthalmology process information were gathered on diabetic patients 18--80 years old who participated in the program during the period July 2003--December 2004.; The integration of telemedicine, such as this teleophthalmology program, within routine health services is attractive. The research, however, indicated that implementation of teleophthalmology in this nonintegrated setting did not improve the annual dilated-eye screening timeframe for the high-risk patients. Merely implementing a teleophthalmology program designed to identify high-risk patients without making overall policy changes and establishing requirements of clinical, technical, administrative, and support qualifications and stakeholder agreements was ineffective in ensuring continuity and quality of care.; This research has shown that there is a need for national policies, including provisions for efficient management of health-technology projects and sufficient audits by funding organizations to ensure compliance with specific program requirements. Future studies should look at the overall cost effectiveness of teleophthalmology implementation in nonintegrated settings.