The overall objective of this proposal is identify and compare Federally Qualified Health Centers (FQHC) eye care screening and treatment for diabetic retinopathy while controlling for an array of socio-economic, demographic and other related factors. Diabetes is the leading cause of blindness among United States (US) adults 40 years and older. Little is known about the prevalence of diabetic retinopathy in the growing US minority, low-income, and uninsured population. Chicago is the third most populous city in the US and comprises 2.7 million people within the city limits, and approximately 10 million in the metropolitan area. It includes multiple world class medical centers, over 70 distinct communities and most segregated areas associated with some of the largest health disparities in the country. The FQHCs are community-based organizations that provide standardized comprehensive care services to persons of all ages, regardless of their ability to pay, and are a critical component o the health care safety net. Many FQHC patients are minorities, do not have insurance, and would otherwise lack access to basic medical care. Providing insight into screening, diagnosis, and treatment (if any) will help to identify areas with greatest need for immediate intervention. The highly innovative Chicago Health Information Technology Regional Extension Center (CHITREC) is an existing database and offers the opportunity to track individual patients (over 2 million in the city of Chicago) across the fragmented health care system to better understand diabetic eye disease, screening, and treatments in the underserved and minorities.
Our aims seek to identify all patients in CHITREC with a diagnosis of diabetes and classify them into three groups (non-FQHC utilization group, FQHC utilization without the presence of an ophthalmologist or optometrist, and FQHC utilization with the presence of an ophthalmologist or optometrist) and assess the difference in the rates of annual eye exams, disease detection, and treatment among these three groups.
Aim 1 will estimate the number of diabetics with an annual eye care exam and Aim 2 will estimate the diabetic retinopathy detection, treatment rate and time to treatment. We will use descriptive techniques and regression models to study utilization and treatments accounting for the site and location, socio-economic, and demographic factors. This proposal allows for the strategic planning with analyses aimed at identifying the areas with the greatest need for the planned placement and infusion of additional ophthalmologists and resources directed at ameliorating the identified health disparities. Subsequently we shall test the use of non-mydratic cameras as an equivalence trial as a long-term cost effective screening strategy for the underserved patients identified and analyzed.

Public Health Relevance

Diabetes is one of the leading causes of blindness in the United States (US) and little is known about the prevalence of diabetic retinopathy in the growing US minority, low-income population. Chicago, IL is the third most populous city in the US and comprises 2.7 million with highly segregated areas and the proposed study will be the first to examine diabetic eye care screening and treatments in minority populations in Federally Qualified Health Centers (FQHC). Results will have practical public health implications aimed at reducing health disparities through identifying and subsequently targeting the most underserved areas of Chicago with additional ophthalmic resources.

National Institute of Health (NIH)
National Eye Institute (NEI)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZEY1)
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Schron, Eleanor
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Northwestern University at Chicago
Internal Medicine/Medicine
Schools of Medicine
United States
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French, Dustin D; Margo, Curtis E; Greenberg, Paul B (2018) Ischemic Stroke Risk in Medicare Beneficiaries with Central Retinal Artery Occlusion: A Retrospective Cohort Study. Ophthalmol Ther 7:125-131
French, Dustin D; Behrens, Jess J; Jackson, Kathryn L et al. (2017) Payment Reform Needed to Address Health Disparities of Undiagnosed Diabetic Retinopathy in the City of Chicago. Ophthalmol Ther 6:123-131
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Mbagwu, Michael; French, Dustin D; Gill, Manjot et al. (2016) Creation of an Accurate Algorithm to Detect Snellen Best Documented Visual Acuity from Ophthalmology Electronic Health Record Notes. JMIR Med Inform 4:e14
French, Dustin D; Margo, Curtis E; Campbell, Robert R (2015) Enhancing postmarketing surveillance: continuing challenges. Br J Clin Pharmacol 80:615-7