Impact of teleretinal screening program on diabetic retinopathy screening compliance rates in community health centers: a quasi-experimental study.

Abstract

Background: Diabetic retinopathy (DR) remains a leading cause of preventable blindness, with inadequate screening rates even in urban areas with high concentrations of medical professionals. While medical guidelines recommend annual diabetic retinopathy screening for patients with diabetes mellitus, adherence to these recommendations remains low. This study evaluates the impact of a novel teleretinal DR screening program on screening compliance across urban community health centers in Boston, Massachusetts.

Methods: We conducted a quasi-experimental study comparing DR screening compliance between intervention and comparison community health centers before and after implementing a teleretinal screening program. Participants included patients diagnosed with diabetes mellitus with primary care providers at the studied sites. We defined compliance as completion of either teleretinal screening or a documented eye care professional examination within the previous 365 days. Monthly compliance rates were analyzed using two-way fixed effects regression and event study techniques.

Results: The study included 10,247 patients with diabetes mellitus who received care at six participating sites, generating 222 monthly compliance rate estimates. Baseline compliance rates before implementation ranged from 25 to 40% across sites. The two-way fixed effects regression analysis revealed that the screening program significantly increased DR compliance rates by an average of 7.2% points (p < 0.001). Event study analysis showed positive effects across all sites, though the initial improvement tended to diminish over time.

Conclusions: Implementation of a community-based teleretinal DR screening program significantly improved compliance with annual screening guidelines in urban communities. These findings support the broader adoption of teleretinal screening as an effective strategy for preventing DR-related vision loss in vulnerable populations. Further research is needed to assess long-term clinical outcomes and optimize program sustainability.