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. 2023 Mar 4;3(3):100295.
doi: 10.1016/j.xops.2023.100295. eCollection 2023 Sep.

Health Disparities in Lapses in Diabetic Retinopathy Care

Cindy X Cai  1 , Diep Tran  1 , Tina Tang  1 , Wilson Liou  1 , Keith Harrigian  2 , Emily Scott  3 , Paul Nagy  4 , Hadi Kharrazi  5 , Deidra C Crews  6 , Scott L Zeger  3
Affiliations

Health Disparities in Lapses in Diabetic Retinopathy Care

Cindy X Cai et al. Ophthalmol Sci. .

Abstract

Objective: To develop a novel methodology to identify lapses in diabetic retinopathy care in electronic health records (EHRs) and evaluate health disparities by race and ethnicity.

Design: Retrospective cohort study.

Subjects: Adult patients with diabetes mellitus who were evaluated at the Wilmer Eye Institute from January 1, 2013 to April 2, 2022.

Methods: The methodology to identify lapses in care first identified diabetic retinopathy screening or treatment visits and then compared the providers' recommended follow-up timeframe with the patient's actual time to next encounter. The association of race and ethnicity with odds of lapses in care was evaluated using a mixed-effects logistic regression model controlling for age, sex, insurance, severity of diabetic retinopathy, presence of other retinal disorders, and glaucoma.

Main outcome measures: Lapses in diabetic retinopathy care.

Results: The methodology to identify diabetic retinopathy-related visits had a 95.0% (95% confidence interval, 93.0-96.6) sensitivity and 98.8% (98.1-99.3) specificity as compared with a gold standard grader. The methodology resulted in a 97.3% (96.2-98.4) sensitivity and 98.1% (97.3-98.9) specificity for detecting a follow-up recommendation, with an average error of -0.05 (-0.31 to 0.21) weeks in extracting the precise timeframe. A total of 39 561 patients with 91 104 office visits were included in the analysis. The average age was 61.4 years. More than 3 (77.6%) in 4 patients had a lapse in care. In multivariable analysis, non-Hispanic Black patients had 1.24 (1.19-1.30) odds and Hispanic patients had 1.26 (1.13-1.40) odds of ever having a lapse in care compared with non-Hispanic White patients (P < 0.001, respectively).

Conclusions: We have developed a reliable methodology for identifying lapses in diabetic retinopathy care that is tailored to a provider's recommended follow-up. Using this approach, we find that 3 in 4 patients experience a lapse in diabetic retinopathy care and that these rates are higher among non-Hispanic Black and Hispanic patients. Deploying this methodology in the EHR is one potential means by which to identify and mitigate lapses in critical ophthalmic care in patients with diabetes.

Financial disclosures: Proprietary or commercial disclosure may be found after the references.

Keywords: Diabetic retinopathy; Health disparities; Lapses in care.

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Figures

Figure 1
Figure 1
Flow diagram for identification of adult patients with diabetes and the diabetes-related office visits in the electronic health record.
Figure 2
Figure 2
Methodology for identifying lapses in diabetic retinopathy care in the electronic health record (EHR). After the initial cohort selection, the ophthalmology office visits related to diabetic retinopathy screening and treatment were isolated (step A), the providers’ recommended follow-up timeframe was identified (step B), the time to the patient’s next office visit was calculated (step C), and the thresholds for defining lapses in diabetic retinopathy care were applied (final). A sample patient’s timeline of different office visits in the EHR is shown on the right with examples of which visits were considered to have lapses in diabetic retinopathy care.
See this image and copyright information in PMC

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