Understanding Diabetic Eye Disease in the Underserved Using Health Data Exchange

The overall objective of this proposal is identify and compare Federally Qualified Health Centers (FQHC) eye care screening and treatment for diabetic retinopathy while controlling for an array of socio-economic, demographic and other related factors. Diabetes is the leading cause of blindness among United States (US) adults 40 years and older. Little is known about the prevalence of diabetic retinopathy in the growing US minority, low-income, and uninsured population. Chicago is the third most populous city in the US and comprises 2.7 million people within the city limits, and approximately 10 million in the metropolitan area. It includes multiple world class medical centers, over 70 distinct communities and most segregated areas associated with some of the largest health disparities in the country. The FQHCs are community-based organizations that provide standardized comprehensive care services to persons of all ages, regardless of their ability to pay, and are a critical component of the health care safety net. Many FQHC patients are minorities, do not have insurance, and would otherwise lack access to basic medical care. Providing insight into screening, diagnosis, and treatment (if any) will help to identify areas with greatest need for immediate intervention. The highly innovative Chicago Health Information Technology Regional Extension Center (CHITREC) is an existing database and offers the opportunity to track individual patients (over 2 million in the city of Chicago) across the fragmented health care system to better understand diabetic eye disease, screening, and treatments in the underserved and minorities. Our aims seek to identify all patients in CHITREC with a diagnosis of diabetes and classify them into three groups (non-FQHC utilization group, FQHC utilization without the presence of an ophthalmologist or optometrist, and FQHC utilization with the presence of an ophthalmologist or optometrist) and assess the difference in the rates of annual eye exams, disease detection, and treatment among these three groups. Aim 1 will estimate the number of diabetics with an annual eye care exam and Aim 2 will estimate the diabetic retinopathy detection, treatment rate and time to treatment. We will use descriptive techniques and regression models to study utilization and treatments accounting for the site and location, socio-economic, and demographic factors. This proposal allows for the strategic planning with analyses aimed at identifying the areas with the greatest need for the planned placement and infusion of additional ophthalmologists and resources directed at ameliorating the identified health disparities. Subsequently we shall test the use of non-mydratic cameras as an equivalence trial as a long-term cost effective screening strategy for the underserved patients identified and analyzed.