Glaucoma is a leading cause of blindness and visual impairment in the United States, particularly among disadvantaged populations. Despite the presence of therapies proven in NEI randomized controlled trials (RCT's) that can be delivered by more than 18,000 ophthalmologists and 34,000 optometrists, almost nothing is known about the content and quality of glaucoma care delivered by non-MD providers such as optometrists. With the numbers of people with glaucoma expected to more than double in the next twenty years in the face of no more than a 15% increase in the supply of eye care providers, methods to better support appropriate and high-quality care for chronic eye diseases such as glaucoma delivered by optometrists will become as critical, if not more so, as techniques to enhance quality care among ophthalmologists. Our proposed study is a community-based, randomized, controlled trial that evaluates the suitability and effectiveness of a technology-based (tablet computer) intervention within the context of a novel partnership between optometrists and patients with glaucoma to improve the process quality of care and ultimately outcomes of care. The tablet computer will collect relevant data, convey contextually appropriate information to both parties, and then provide feedback and recommendations to both the patient and the provider about the current visit and future steps in care, based on American Optometric Association (AOA) guidelines. The intervention arm is based on novel applications of existing technology for both patients and providers used in past and current studies and on innovative methods of enhancing quality of care. It expands the use of electronic health systems to include patients in their own care. A control group will be exposed to usual and customary continuing professional education (for the optometrists) and standard patient educational materials (for the patients). By using successfully implemented technology in novel applications, and by building on the success of ongoing community-based quality improvement projects in our region, the study provides a means for rapid translation into community care if the intervention is successful. Public Health Relevance: If successful, not only will the methods of the study be able to be directly implemented for glaucoma care but the insights should also be applicable to other chronic eye diseases and to any other chronic medical condition. Further, such techniques would provide insights to assist non-physician providers to provide high quality care throughout health care.

Agency
National Institute of Health (NIH)
Institute
National Eye Institute (NEI)
Type
Research Project (R01)
Project #
5R01EY018405-05
Application #
8121570
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Schron, Eleanor
Project Start
2007-09-30
Project End
2013-07-31
Budget Start
2011-08-01
Budget End
2013-07-31
Support Year
5
Fiscal Year
2011
Total Cost
$627,969
Indirect Cost
Name
Duke University
Department
Ophthalmology
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705