November is National Diabetes Awareness Month

November is National Diabetes Awareness month and Community Health Center, Inc. is leading the way among federally qualified health centers (FQHC) in Connecticut in the ability to quickly and effectively diagnosis diabetic retinopathy among at-risk patients.

People living with diabetes are at risk for developing three eye diseases: diabetic retinopathy, cataracts and glaucoma. If left untreated, these diseases can cause blurred vision, bleeding in the eyes and blindness.  In fact, diabetic retinopathy is the leading cause of acquired blindness in adults in the United States. The best way to prevent diabetic eye disease is to control both blood sugar levels and blood pressure. Often, these diseases have no symptoms early on their progression, and this is when they are most treatable.  While progression of diabetic retinopathy can be slowed or halted, vision that has been lost cannot be regained. Therefore, it is very important for all individuals with diabetes to receive screening for diabetic eye diseases, including diabetic retinopathy, regularly.

Diabetic retinopathy is a growing epidemic affecting more than 20 million Americans of all ages, gender, and race. Early detection prevents progression and currently, screening rates are only 10% in medically underserved populations. Diabetes prevalence is expected to double or triple in the next few decades, with one-third of U.S. adults expected to have diabetes by 2050.

In August, a report that found improved diabetic retinopathy (DR) screening through a statewide telemedicine program was published by the Johns Hopkins University Press in the Journal of Health Care for the Poor and Underserved (Volume 22, Number 3, August 2011).  The study, which was conducted by Community Health Center, Inc. in conjunction with the Yale Eye Center/Department of Ophthalmology, supported telemedicine, using digital imaging technology in the primary care office, as a strategy that can be used to screen underserved and at-risk patients for DR, increase compliance with screening, and streamline specialist referrals.

Through a partnership with the Yale Eye Center/Department of Ophthalmology, Community Health Center, Inc. launched a telemedicine-based diabetic retinopathy (DR) screening program within its 12 primary care centers in July 2009 in order to improve screening, detection and referral rates for DR, based on a 2009 internal review where CHC found that only 10-12% of its patients with diabetes were up to date with recommended DR screening.

During the study, over 600 patients with diabetes were screened for diabetic retinopathy in concert with a comprehensive nurse visit. Retinal images and patient data were uploaded into the EyePACS® web-based Picture Archiving System to be retrieved and reviewed by specialists at Yale. Reports indicating retinopathy level and referral recommendations were transmitted back to primary care providers through the website. Retinal screening rates doubled with this program and for the 25% of screened patients who were uninsured, this program was the only way for them to receive this recommended screening. Only 13% of patients required specialist referral.  The program has been demonstrated to be cost-saving as well, and a detailed cost-effectiveness study on the same program will be published in Connecticut Medicine soon (Huang, Olayiwola et al).

 “This study provides foundational insights on how best to apply a patient-centered medical home model to an established medical problem, using technology, team-based care and patient education,” noted Dr. J. Nwando Olayiwola, MD, MPH, FAAFP, Chief Medical Officer and Family Physician at Community Health Center, Inc.  “Fortunately, a program with such important clinical implications has also demonstrated its cost efficacy ,” she added.

The study was led by Dr. Olayiwola, and included the expertise of Dr. Diana Sobieraj, Research Associate at the University of Connecticut School of Pharmacy and Hartford Hospital; Ms. Kathryn Kulowski, Optometry Student at New England College of Optometry and former student researcher at Community Health Center, Inc. in Middletown; Mr. Daniel St. Hilaire, the former Diabetic Retinopathy Program Coordinator at Community Health Center, Inc. in Middletown and current Research Assistant at the Brigham and Women’s Hospital; and Dr. John Huang, Associate Professor, Residency Program Director, and Director of Ocular Immunology and Uveitis Service at the Yale University Department of Ophthalmology. 

About Community Health Center, Inc. 
Since 1972, Community Health Center, Inc. has been one of the leading healthcare providers in the state of Connecticut, building a world-class primary health care system committed to caring for underserved and uninsured populations. CHC is focused on improving health outcomes for its more than 130,000 patients as well as building healthy communities. Currently, CHC delivers service in 218 locations statewide, offering primary care in medical, dental and behavioral health services.