Utilization of Remote Diabetic Retinal Screening in a Suburban Healthcare System

Figures & data

Table 1 Characteristics of Patients Who Underwent Remote Screening

Characteristics	All Patients (n=1402)	Group		p-value^†
		Remote Screening (n=214)	No Remote Screening (n=1188)
Continuous Variables
Age (yrs.)
Mean (SD)	64.4 (13.6)	62.3 (12.5)	64.7 (13.8)	0.014
Median	65	62	65
Range	19–100	19–95	19–100
HbA1c (%)
Mean (SD)	7.3 (1.6)	7.4 (1.7)	7.2 (1.5)	0.115
Median	6.9	6.9	6.9
Range	4.0–14.0	4.2–13.5	4.0–14.0
Distance to Clinic (miles)
Mean (SD)	10.6 (22.9)	12.9 (16.6)	10.2 (23.9)	0.372
Estimated Household Income ($ thousands)
Mean (SD)	91.5 (35.3)	95.1 (35.7)	90.8 (34.8)	0.112
Categorical Variables
Gender (%)
Male	65	74	63	0.002
Type of Diabetes (%)
Type 2	92	95	92	0.064
Race (%)
White	91	91	91	0.809
Asian	2	4	2	0.086
Black	<1	<1	<1	0.365
Hispanic	<1	<1	<1	0.994
Other^§	5	3	5	0.332
Insurance Type (%)
Commercial	33	38	32	0.089
Medicare	53	44	55	0.005
Medicaid	13	17	12	0.056

Notes: Significance is marked in bold (p < 0.05). ^†Statistical analysis was performed between the Remote Screening and No Remote Screening groups. ^§Includes individuals self-reporting more than one race.

Table 2 Individual Biometric and Sociomedical Factors Associated with Remote Screening

Variable	Remote Screening (n = 214)	No Remote Screening (n = 1188)	p-value^†
Primary Care Office Visit in Last Year	100%	66%	<0.001
Diabetic Eye Exam in Last Year	73%	53%	<0.001
HbA1c Measured in Last Year	91%	83%	<0.001
HbA1c < 8.0%	67%	77%	0.005
BP <140/90 mmHg	81%	75%	0.086
LDL <100 mg/dL	65%	66%	0.703
Obesity (BMI > 30)	64%	54%	0.007
Diabetic Nephropathy	7%	10%	0.220
Peripheral Neuropathy	36%	33%	0.415
Microalbumin Screening in Last Year	83%	79%	0.272

Note: ^†Statistical analysis was performed using χ² test with significance marked in bold (p < 0.05).

Abbreviations: HbA1c, hemoglobin A1c; BP, blood pressure; LDL, low-density lipoprotein level; BMI, body mass index.

Table 3 Logistic Regression of Multiple Variables Demonstrating Odds of a Patient Receiving Remote Screening

	β	Standard Error	Wald χ^2	p-value^†	Adjusted OR	95% CI
						Lower-Bound	Upper-Bound
Diabetic Eye Examination in Last Year	1.713	0.181	89.263	<0.001	5.548	3.888	7.915
Obesity (BMI > 30)	0.714	0.169	17.819	<0.001	2.042	1.466	2.845
HbA1c ≥ 8.0%	0.469	0.178	6.961	0.008	1.598	1.128	2.265
Age	−0.015	0.006	5.823	0.016	0.985	0.973	0.997

Note: ^†Significance is marked in bold (p < 0.05).

Abbreviations: HbA1c, hemoglobin A1c; BMI, body mass index.

Table 4 Time-Driven Activity-Based Costing of the Estimated Cost of Implementing Remote Diabetic Retinopathy Screening According to the Personnel Involved

	Required Personnel	Annual Salary ($)	Hours Worked	Wage ($) Cost/Hour	Time Required to Complete (Hours)	TDABC/Examination ($)
In-person Eye Examination	Ophthalmologist	299k	1800	166	0.25	41.53
In-person Eye Examination	Optometrist	127k	1800	71	0.25	17.64
Remote Screening Examination	Medical Assistant	N/A	1800	17	0.20	3.40
Image Grading	Ophthalmologist	299k	1800	166	0.03	4.98

Abbreviation: TDABC, time-driven activity-based costing.