Integrated Delivery Networks Facilitate Diabetic Eye Examination Completion and Communication

Integrated delivery networks (IDNs) enhance care for patients with diabetes by improving communication between specialists who perform eye examinations and primary care providers (PCPs). In this study, we aimed to identify factors associated with receiving eye care outside of an IDN and evaluate how leakage affects coordinated diabetes management.

The study included 1,139 patients aged 18-75 with diabetes who received primary care in an IDN and had health insurance coverage provided by an accountable care organization (ACO). Claims data were reviewed to determine the rate at which completed eye examinations were communicated to PCPs. Patient demographic and biometric factors were analyzed using logistic regression to investigate their association with completion of an eye examination out-of-network.

A total of 772 patients completed eye examinations, 37% elected to do so out of network. Patients who received out-of-network eye care were less likely to have good glycemic control (A1c < 8.0%: 70.4% vs. 79.2%, p = 0.008), more likely to have poor glycemic control (A1c > 9.0%: 14.3% vs. 8.0%, p = 0.009), and had fewer documented diabetes-related complications (diabetic retinopathy: 7.7% vs. 17.3%, p < 0.001). Whereas all eye examinations completed within network were available through the electronic health record (EHR), fewer than three-quarters of eye examinations completed outside network were communicated back to PCPs (100% vs. 74%, p < 0.001).

Ophthalmologists practicing outside of IDNs need to strengthen communication of eye examination results, particularly for patients at risk of complications from poorly-controlled diabetes.