Short-Term Outcomes of Two Interventions for Patients With Active Proliferative Diabetic Retinopathy in an Urban, Safety-Net Hospital.

Abstract

Background: Proliferative diabetic retinopathy carries significant visual morbidity and loss to follow-up can lead to poorer visual outcomes. This study aims to evaluate the short-term impact of two systems-focused clinical initiatives directed toward reducing loss-to-follow-up and increasing pan-retinal photocoagulation (PRP) rates in patients with active proliferative diabetic retinopathy (PDR) in an urban, safety-net, teaching-hospital setting. The introduction of an additional weekly PRP clinic was followed by the creation of an active PDR patient registry with an appointment reminder system.

Methods: This was a single-center, observational, retrospective cohort study between December 2022 and May 2024. We established three cohorts of encounters based on the number of eyes with active PDR in sequential order: historical controls (115 encounters) in the 8 months preceding the first intervention, increased provider PRP volume (74 encounters) over the next 4 months, and patient registry with an appointment reminder system in addition to increased provider PRP volume (65 encounters) for the following 4 months. We used linear and generalized linear mixed-effects models clustered at the patient level. Short-term process measures included the number of monthly PRP clinics, time to PRP after referral, rates of PRP and full PRP, PRP clinic adherence rate, 3-month ophthalmology clinic adherence rate, and 3-month loss-to-follow-up rate.

Results: The introduction of an additional weekly PRP clinic was associated with a decrease in time from referral to PRP by 37 days (p < 0.001), increased odds of 3-month PRP (odds ratio [OR]: 6.53; 95% confidence interval [CI]: 3.03-14.10; p < 0.001) and 3-month full PRP (OR: 4.66; 95% CI: 2.22-9.78; p < 0.001). Subsequent introduction of a patient registry/appointment reminder system was associated with decreased odds of 3-month loss-to-follow-up (OR: 0.10; 95% CI: 0.01-0.79; p < 0.05) compared to historical cohort and improved odds of 3-month ophthalmology clinic adherence (OR: 2.96; 95% CI: 1.18-7.47; p < 0.05) compared to the increased PRP clinic cohort.

Conclusions: Dedicating additional clinic time for PRP and introducing a high-risk registry and reminder system were associated with improved access to care, reduced loss-to-follow-up, and increased overall clinic adherence in an urban, safety-net hospital system. Long-term visual and functional outcomes of these initiatives are an essential area of future study.