Oklahoma Community Health Services

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					  Diabetic Retinopathy:
   A technological and
innovative intervention
 to improve detection of
  target organ damage
             S. Naidu, MD, MPH, FAAFP
                   Medical Director
       Oklahoma Community Health Services, Inc.
Payer Mix in Study Group

– Improve screening of patients for diabetic
  eye disease.
– Evaluate the need for an affordable
  program to implement retinal screening in
  diabetic patients.
– Determine and document underlying
  disease in an unevaluated population.
Oklahoma Community Health Services
(OCHS) has a diabetic population of 862
and is a participant in the National
Diabetic Collaborative program. The
diabetic population is 64% uninsured
and has only 5% covered by commercial

    A pre-intervention chart audit was conducted on all
    diabetic patients within OCHS. Data regarding
    baseline ophthalmologic evaluations were collected.


    Every diabetic patient was invited by letter and
    telephone to participate in the study and undergo
    retinal imaging. Over a period of one month, 365
    patients were enrolled for free iScan screening.
iScan Technology

The chart audit revealed baseline
compliance of 4.5%. The iScan intervention
over a period of one month bolstered
compliance to 42%.
               Left Eye

                           No ME ME not CS   MHE   CSME   CE
   Right Eye

                 No ME      302      2        2     5     8    319

               ME not CS     1                      1           2

                  MHE                3        3     1     1     8

                 CSME        2                2     7     5    16

                   CE        5                2           13   20

                            310      5        9     14    27   365

302 patients (83%) had normal retinal scans; 60 (16%)
received recommendation for referral to ophthalmology. Of
those 60 patients, 8 (13%) were referred for macular hard
exudates, 18 (30%) for clinically significant macular
exudates; and 34 (57%) for poor image quality or cataracts.

1. Since the cost of the iScan usually represents 30%
   of the cost for ophthalmologic referral, the
   intervention resulted in an enormous conservation
   of financial resources, revealing a large proportion
   of diabetic patients with normal retinal scans.
2. The intervention dramatically improved diabetic
   retinal screening in a short period of one month.
3. The need for a cost effective, efficient modality for
   diabetic retinal screening was dramatically
1. Clinics with restricted resources often do not have affordable
   programs to screen for diabetic retinopathy, and this
   program allows for tremendous savings since a large
   proportion of patients had normal retinal screening.
2. The iScan retinal imaging program is high-quality,
   convenient, and cost-effective in bringing affordable
   technology to provide essential screening for diabetic
   retinopathy, leading to early intervention, improved
   outcomes, and avoidance of expensive and invasive
3. Implementation of this cost-effective technology has
   enhanced the detection of disease and increased the referral
   rate to ophthalmology for appropriate disease-specific
   patients. This still resulted in tremendous savings to the
   system as the retinal screening was already completed.
4. This technology offers a novel approach to develop new policy
   for retinal screening within the health-care setting. An
   additional opportunity exists for multiple facilities in close
   proximity - to cost-share - making this a viable program.

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