Population-Level Teleretinal Screening Bulk Orders to Improve Diabetic Retinopathy Screening Rates: A Randomized...

Diabetic retinopathy (DR) is a leading cause of blindness; however, many patients with type 2 diabetes (T2DM) are not up to date with screening guidelines. This study explored the impact of teleretinal screening bulk orders on the DR screening completion rate.

In this randomized controlled trial, eligible patients with T2DM due for DR screening were randomly assigned to receive a teleretinal screening bulk order at one of four monthly time points, following a stepped-wedge design. Teleretinal screening bulk orders are placed by a centralized provider for a defined patient cohort. They include a retinal fundus photo order and an associated electronic patient education message. Logistic regression at the patient-month level, with errors clustered at the patient level, was used to evaluate the effect of bulk orders on DR screening completion rate. Two-stage least squares was used to evaluate the effects of opening the message, using random assignment as an instrument.

A total of 5,665 eligible patients were identified for this study. At six months from the first bulk order, the overall DR screening completion rate was 17.5% (n = 994). Receiving a bulk order increased odds of completing screening (odds ratio [OR]: 1.78; confidence interval [CI] 95%: 1.49, 2.14; p < 0.001). 2,763 patients (48.7%) opened the electronic patient message. Opening the message increased completion rates by 8.5% (95% CI; 6.0%, 11.1%; p < 0.001) and retinal fundus photo appointments scheduled by 19.1% (95% CI; 16.8%, 21.3%; p < 0.001).

Teleretinal screening bulk orders were associated with a significant increase in DR screening. Population-level interventions should be implemented to improve diabetes preventative care.