Seeing the Difference: A Multifactorial Approach to Increase Diabetic Eye Exam Completion

Diabetic retinopathy remains a leading cause of vision loss, yet screening rates remain suboptimal. Patients face barriers to timely diabetic eye screenings, including limited access to care in rural settings and inconsistent referral and documentation processes. Using the Model for Improvement, iterative cycles addressed clinic-level gaps through a multicomponent strategy that included provider-led patient education, a standardized referral process, and enhanced documentation practices for accurate reporting. Screening referral and completion rates increased from 53.8% to 69.9% over 1 year. Patients who received provider-led education using models and pictures reported clarity, sufficient time to understand the information, and plans to schedule a screening eye exam. Workflow changes improved reporting of quality metrics through enhanced documentation and higher rates of diabetic eye exams, with potential downstream benefits including cost savings from improved performance metrics and the prevention of diabetes-related vision loss.