The Path to Improving Diabetic Retinopathy Outcomes: Evaluating Neighborhood Characteristics and Healthcare Quality

Abstract
Diabetic retinopathy is a leading cause of preventable, irreversible blindness in the United
States. The risk of blindness from diabetic retinopathy can be minimized, but relies on a)
appropriate screening for early identification of DR, b) regular monitoring once DR has been
identified, and c) appropriate treatment as DR progresses to more advanced stages. At least
one third of patients with diabetes in the United States do not receive annual dilated eye exams
for screening, as recommended by the American Academy of Ophthalmology guidelines.
Further, up to 25% of patients with identified DR do not receive appropriate monitoring after
diagnosis. The central hypothesis of the proposed work is that neighborhood and community
characteristics, encompassed in the area deprivation index (ADI), will be as or more important
than individual patient characteristics for explaining nonadherence to DR screening and
monitoring. The specific aims of our study are to 1) Evaluate the impact of patient,
neighborhood, and community characteristics on patterns of screening for DR among Medicare
beneficiaries with diabetes mellitus and to 2) Evaluate the impact of patient, neighborhood, and
community characteristics on patterns of follow-up and incidence of vision-threatening
complications from DR. Using Medicare data linked with ADI and measures of local healthcare
environment characteristics, we will use a repeated measures modeling strategy to (1) identify
factors associated with adherence to recommended screening intervals over time within a
population of patients at risk for developing DR and to (2) identify factors associated with
adherence to recommended monitoring intervals over time with a population of patients with
DR. We will also use a time-to-event modeling strategy to identify factors associated with the
development of DR complications. Results based on our proposed work with nationwide health
data could be used to inform quality measures and reimbursement incentives, decrease cost of
care, and improve health equity by better allocating resources to decrease the rising incidence
of preventable, irreversible blindness in the 10 million people in the US with diabetic retinopathy.

Grant Number: 5R21EY036605-02
NIH Institute/Center: NIH
Principal Investigator: DURGA BORKAR