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

Figures & data

Figure 1. CONSORT diagram of eligibility, exclusions, randomization, outcome, and analysis.

Table 1. Eligibility for the Sendero Health Plan 2017 retinal eye exam campaign for members with type 2 diabetes.

Specification	Description
Age Range	Individuals aged 18–90 years as of December 31, 2017
Intervention time frame	September 17, 2017 through October 31, 2017
Disease status	ICD-9 Codes to indicate type 2 diabetes with either a 0 or 2 as a fifth digit modifier 250.0, diabetes mellitus without mention of complication 250.1, diabetes with ketoacidosis 250.2, diabetes with hyperosmolarity 250.3, diabetes with other coma 250.4, diabetes with renal manifestations 250.5, diabetes with ophthalmic manifestations 250.6, diabetes with neurological manifestations 250.7, diabetes with peripheral circulatory disorders 250.8, diabetes with other specified manifestations 250.9, diabetes with unspecified complication	ICD-10 Codes to indicate type 2 diabetes, with the * serving as a place holder for additional modifier codes E11*, type 2 diabetes
Eye exam status	Individuals who did not have an eye examination from January 1, 2017–July 1, 2017 based on the following primary and/or secondary CPT or HCPCS retinal eye codes: Primary CPT code indicating an office visit for an eye exam 92004 92012 92014 Secondary CPT code indicating a retinal eye examination was performed 2022F 2024F 2026F 3072F HCPCS code indicating a retinal eye examination was performed S0620 S0621 S3000
Ongoing treatment	No ongoing care or treatment of ocular complications typically associated with diabetes mellitus
Provider type	Optometrist Ophthalmologist Non-Eye Care Provider (e.g., family medicine or internal medicine physician)

CPT: Common Procedural Terminology code; HCPCS: Healthcare Common Procedure Coding System; ICD: International Classification of Diseases

Table 2. Demographic variables and codes used for statistical analyses.

Variable	Description
Sex	The members sex
Age	The members age in years
County of Residence	The member’s county of residence
Date of Service	The date in which the member obtained the eye exam
CPT Codes – Eye Care Outpatient Examination Codes	Common Procedural Terminology codes 92004, 92012, and 92014 used to indicate a visit for an outpatient eye care examination, excluding vision services for corrected lenses
CPT Codes – Retinal Exam Category II Codes	Common Procedural Terminology codes 2022F, 2024F, 2026F, and 3072F used to indicate a retinal eye exam
HCPCS – Retinal Exam Codes	Healthcare Common Procedure Coding System codes S0620, S0621, S3000

CPT: Common Procedural Terminology code; HCPCS: Healthcare Common Procedure Coding System

Table 3. Demographic variables of diabetic members who were assigned to and who obtained a retinal eye exam between September 17, 2017 and October 31, 2017.

Variable	Baseline Demographic Information for Eligible Participants*	Control (1) n = 38	$25 Incentive (2) n = 38	Education Only (3) n = 41	Incentive and Education (4) n = 31	Total Groups 1, 2, 3, 4 N = 148
Sex	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
Female	760 (52.5%)	19 (50.0%)	21 (55.3%)	27 (65.9%)	20 (64.5%)	87 (58.8%)
Male	688 (47.5%)	19 (50.0%)	17 (44.7%)	14 (34.1%)	11 (35.5%)	61 (41.2%)
Age	Years	Years	Years	Years	Years	Years
Mean [SD]	52.85 [10.9]	56.79 [9.40]	56.32 [8.84]	57.27 [9.24]	54.97 [10.0]	56.42 [9.29]
Median	55.00	57.50	57.50	59.00	58.00	58.00
Range	18-90	35-81	32-79	27-83	29-71	27-83

SD: Standard deviation

* Age based on N = 1,447 and county and sex based on N = 1,448 due to missing data

Table 4. Number and percent of diabetic members who were assigned to and who obtained a retinal eye exam between September 17, 2017 and October 31, 2017.

	Obtained Retinal Eye Exam	Did Not Obtain Retinal Eye Exam
Group Assigned	Number (%)	Number (%)	Relative Risk (95% CI)	P Value*
Control Group (1) (n = 597)	38 (6.8%)	559 (93.6%)	Referent	-
Incentive Only (2) (n = 287)	38 (15.3%)	249 (86.8%)	2.08 (1.36–3.19)	<.001
Education Only (3) (n = 289)	41 (16.5%)	248 (85.8%)	2.23 (1.47–3.39)	<.001
Education and Incentive (4) (n = 281)	31 (12.4%)	250 (89.0%)	1.73 (1.10–2.73)	.017
Total	148 (11.3%)	1,306 (89.8%)

* P value obtained from a Pearson chi-square test of independence comparison to the referent group.