The primary objective of this study is to evaluate effectiveness of two strategies, separately and in combination, for increasing rates of dilated eye exams among predominantly minority patients with diabetes. One strategy focuses on primary care physicians and the other focuses on patients. A total of 132 primary care physicians and 1,320 of their patients who have not had a dilated eye exam in the last 14 months will be enrolled and randomized into one of four groups: (1) A control group (expected exam rate = 30%); (2) Patients of physicians receiving an innovative form of medical education referred to as academic detailing (expected exam rate = 45%); (3) Patients receiving tailored telephone education (expected exam rate = 60%); and (4) Patients receiving tailored telephone education as well as being patients of physicians receiving academic detailing (expected exam rate = 75%). Endpoints are medically documented dilated eye exams at 8 months post-randomization. Secondary objectives are determining the extent to which exam rates are maintained at 24 months post-randomization, identifying variables that explain how and for whom the interventions worked, documenting the extent of disease identified and follow-up care received, and determining cost-effectiveness. The sample will be drawn from approximately 2,875 physicians that are for about 9,225 predominantly low-income minority patients who are members of the 1199 Nation Benefit Fund, the largest health care workers benefit fund in the nation. Even though dilated eye exams are available to 1199 members at no cost, the current rate of annual exams in this population is about 30%, which is considerably lower than the national average of about 47%. Measurements entail monitoring implementation of the interventions, assessing hypothesized mediating variables, and ascertaining outcomes by multiple methods, including medical record audits by research staff that is not aware of patient's group assignment. Statistical analyses involve using generalized estimating equations to compare exam rates across groups of patients nested within providers. This study is innovative in applying techniques used extensively by the pharmaceutical industry (physician detailing) and techniques used widely by the telemarketing industry (telephone outreach) as strategies for increasing dilated eye exams. These interventions are practical, have potential for widespread dissemination, and can translate basic and clinical research to achieve public health benefits.
