Redesigning Clinical Pathways for Immediate Diabetic Retinopathy Screening Results

Regular diabetic retinopathy (DR) screening and early treatment can prevent DR-associated vision loss. However, some DR screening programs within primary care settings have found low rates of patient adherence to referral recommendations, even following a positive screen for vision-threatening DR. The authors hypothesized that adherence can be increased by providing screening results immediately and improving workflows by engaging patients and, when needed, scheduling a follow-up ophthalmology appointment immediately. A long-term goal of this project is to investigate the potential value of an immediate clinical image interpretation provided by artificial intelligence (AI); however, in this study, optometrists simulated AI by providing immediate reads of the fundus images. Immediate interpretation, which formed the basis for counseling and recommendations while the patient was in the office, resulted in significantly improved adherence among patients who received a recommendation to see a specialist within 1 month, from the historical baseline of 35% to 72% (P < .01 after controlling for cohort characteristics). This suggests that providing results and scheduling follow-up appointments immediately following a DR screening test can substantially improve patient adherence and reduce unnecessary vision loss. The changes were adopted widely within the hospital system and even scaled to include referrals to other specialties.