A Randomized Controlled Trial to Increase Diabetic Retinopathy Screening by a Community-Based Health Insurance Plan in Central Texas – 2017

ABSTRACT

Purpose

Diabetic retinopathy is a leading cause of blindness worldwide. In the United States, the prevalence of diabetic retinopathy is 26% – 33%. Providing preventive care to individuals with diabetes is important to prevent microvascular complications in the eye. This study reports on the results of a randomized controlled trial to determine how using specific cues to action combined with the provision of a free eye exam might positively influence the rate of diabetic retinopathy screening among individuals with diabetes.

Methods

Individuals were eligible to participate in this campaign if they had a diagnosis of type 2 diabetes or were prescribed a diabetes drug, were members of the health insurance plan during the intervention period and had no evidence of receiving a retinal eye exam prior to the campaign period. The six-week campaign period started on September 19, 2017 and ended on October 31, 2017. A total of 1,454 individuals with type 2 diabetes were randomly assigned to a control group or to one of three intervention groups. Each intervention group included the provision of a free eye exam.

Results

A total of 148 (10.1%) individuals obtained a retinal eye exam during the six-week campaign period with 38 persons (6.8%) in the control group, 38 (15.3%) in the incentive group, 41 (16.5%) in the education group, and 31 (12.4%) in the incentive and education group. Individual intervention comparisons with the referent group yielded statistical significance using the adjusted pairwise alpha of P = .008 for the incentive group (RR = 2.08; 95% CI, 1.36–3.19; P =.0006) and for the education group (RR = 2.23; 95% CI, 1.47–3.39; P =.0001), but not in the incentive plus education group (RR = 1.73; 95% CI, 1.10–2.73; P =.017).

Conclusion

This study supports the use of targeted cues to action combined with the provision of a free eye exam to increase the rates of diabetic retinopathy screening among individuals with diabetes who have health insurance coverage under the Affordable Care Act in a Central Texas population.

KEYWORDS:

• Diabetic Retinopathy
• Health Maintenance Organization
• incentives
• Affordable Care Act
• Sendero Health Plans

Ackowledgements

The authors would like to acknowledge the assistance and advice of current and former Sendero staff members and contractors Linda Burton, Norma Lozano, Rodolfo Ybarra, Priscilla Gonzales, Dr. Milton Thomas, and Dr. Avishek Kumar in the development of this project. The authors would also like to acknowledge Travis County taxpayer support of Sendero Health Plans.

Declaration of interest statement

Dr Litaker, Dr. Taylor, and Ms. Tamez are paid contractors to Sendero Health Plans. Mr. Durkalski is employed by Sendero Health Plans. Mr. Palma was formerly an intern with Sendero Health Plans. Funding for this project was provided in the form of staff and contractor time by Sendero Health Plans.

Institutional review board approval

This project received ethics approval by Aspire IRB on July 13, 2017, IRB Number: 2016F-09.

Registration

ISRCTN Registry

Registration Number: ISRCTN 87443551

Link: https://doi.10.1186/ISRCTN87443551

Additional information

Funding

This project was funded by Sendero Health Plans as an internal quality improvement initiative.