Glaucoma is a leading cause of irreversible blindness in the United States. Yet, at least one-half of glaucoma patients do not take the medications that are proven to prevent vision loss. Current clinical practice lacks a strategic framework to address this issue. The overarching objective of the proposal is to improve adherence while maximizing the efficiency of our ophthalmic healthcare workforce. The project aims to leverage technology to support medical provider teams to deliver high-quality individualized education and counseling that would otherwise be available only through an extended conversation with a physician. The project will use operations engineering (OE), a field whose goal is to optimize efficiency in complex systems and processes, to provide a framework to increase the efficiency of clinic visits in order to integrate individualized counseling and support into standard care. OE tools will be used to analyze scheduling, work- flow and work-allocations to optimize the application of team-based eye care to improve support for patient's self-management behaviors. The proposed counseling strategy will be designed to maintain patient access to glaucoma specialty services by allowing the same level of patient volume. This work will refine and pilot test the eyeGuide, a computer-based personalized behavior change program that enables medical assistants with brief training to motivate and support glaucoma patients to improve their self-management and medication adherence. The PI and her mentorship team have developed a prototype of the eyeGuide. In this program, medical assistants are trained in motivational interviewing-based approaches to use the eyeGuide to deliver individualized information and coaching to each patient. The eyeGuide will be refined based on information gathered in an operations engineering (OE) analysis of current clinical practice. OE value stream mapping will be used to identify when to include additional education and counseling during a patient's clinic visits. OE computer modeling techniques will be used to generate different theoretical models in which to test how to optimally integrate additional counseling and education into glaucoma patient care. The eyeGuide program will be refined based on these analyses and pilot tested with non-adherent glaucoma patients. Its effect on adherence, monitored in real time, and psychosocial mediators of adherence will be evaluated. The proposed training and research will prepare Dr. Newman-Casey to become an independent glaucoma researcher, with skills in effective health communication, operations engineering, and mixed methods intervention design and analysis. In light of the growing prevalence of glaucoma as the US population ages and concomitant projected shortages of ophthalmologists, the design, implementation and evaluation of systems-based approaches towards an improved model of patient centered eye care is critically important.

Public Health Relevance

Despite effective treatments, glaucoma is a leading cause of blindness in the United States. At least one-half of patients do not take their medication, making poor medication adherence a critical barrier to reducing the burden of vision loss from glaucoma. This project develops and tests technology-based individually tailored behavior change programs designed to motivate glaucoma patients to improve their medication adherence. The project uses operations engineering techniques to identify ways to refine the program so that it can be best integrated into patients' regular glaucoma care. This project is relevant to the NIH and NEI mission, as it creates targeted educational programs with the aim of preventing blindness.

National Institute of Health (NIH)
National Eye Institute (NEI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZEY1)
Program Officer
Agarwal, Neeraj
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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