abstract: 'BACKGROUND: Diabetes mellitus remains the leading cause of new cases of

  blindness among US adults. Routine dilated eye examinations can

  facilitate early detection and intervention for diabetes-related eye

  disease, providing an opportunity to reduce the risk for

  diabetes-related blindness in working-aged Americans. The Healthcare

  Effectiveness Data and Information Set (HEDIS) established criteria for

  performing dilated eye examination in patients with diabetes.

  OBJECTIVES: To obtain information about adherence and nonadherence to

  diabetic eye examinations among insured patients to understand the

  barriers to routine dilated eye examinations, and to identify ways to

  improve the quality of care for these patients.

  METHODS: This retrospective claims analysis is based on administrative

  claims from the HealthCore Integrated Research Database, a broad

  database representing claims from a large commercially insured

  population. Patients with diabetes and who had >= 1 dilated eye

  examinations between August 1, 2011, and July 31, 2013, were defined as

  adherent to the HEDIS recommendations. The analysis was augmented with

  findings from focus groups. The patient focus groups included adherent

  and nonadherent patients. The provider focus group participants were

  general practice or internal medicine physicians and ophthalmologists

  who provided medical care for the study population. For the

  administrative claims analysis, comparisons between the adherent and

  nonadherent patients were performed using t-tests for continuous data

  and chi-square tests for categorical data.

  RESULTS: Of 339,646 patients with diabetes identified in a claims data

  set, 43\% were adherent and 57\% were nonadherent to the HEDIS eye

  examination performance measure. The common barriers to routine eye

  examination cited by 29 patients across 4 focus groups included a lack

  of understanding of insurance benefits (N = 15), a lack of awareness of

  the importance of dilated eye examinations (N = 12), and time

  constraints (N = 12). The common barriers cited by 18 providers included

  the patient''s level of education (N = 13), eye examinations as a lower

  priority than the management of other diabetes-related health issues (N

  = 12), and a lack of symptoms (N = 11).

  CONCLUSION: Several reasons for patient nonadherence to routine eye

  examination were identified, including a lack of understanding of

  insurance benefits, a lack of awareness or low prioritization of having

  an examination, patient education level, time constraints, and a lack of

  symptoms. These may be considered by providers and payers when

  developing programs to increase the rates of eye examinations and

  improve outcomes among patients with diabetes.'
affiliation: 'Fisher, MD (Corresponding Author), Real World Evidence, Vector Oncol,
  Memphis, TN 38119 USA.

  Fisher, Maxine D., Real World Evidence, Vector Oncol, Memphis, TN 38119 USA.

  Fisher, Maxine D.; Gu, Tao; Singer, Joseph R.; Barron, John, HealthCore, Wilmington,
  DE USA.

  Rajput, Yamina; Ryu, Seonyoung, Genentech Inc, San Francisco, CA 94080 USA.

  Marshall, Amanda R., HealthCore, Res Data Collect, Wilmington, DE USA.

  MacLean, Catherine, Hosp Special Surg, 535 E 70th St, New York, NY 10021 USA.'
author: Fisher, Maxine D. and Rajput, Yamina and Gu, Tao and Singer, Joseph R. and
  Marshall, Amanda R. and Ryu, Seonyoung and Barron, John and MacLean, Catherine
author_list:
- family: Fisher
  given: Maxine D.
- family: Rajput
  given: Yamina
- family: Gu
  given: Tao
- family: Singer
  given: Joseph R.
- family: Marshall
  given: Amanda R.
- family: Ryu
  given: Seonyoung
- family: Barron
  given: John
- family: MacLean
  given: Catherine
da: '2023-09-28'
eissn: 1942-2970
files: []
issn: 1942-2962
journal: AMERICAN HEALTH AND DRUG BENEFITS
keywords: 'adherence; diabetes mellitus; dilated eye examination; HEDIS measures;

  nonadherence; ophthalmologists; primary care physicians'
keywords-plus: AFRICAN-AMERICANS; CARE; INTERVENTION; KNOWLEDGE; REMINDERS
language: English
month: OCT
number: '7'
number-of-cited-references: '29'
pages: 385-392
papis_id: 08c02c916b9230fc7fe55dff7ba6afde
ref: Fisher2016evaluatingadherence
times-cited: '8'
title: Evaluating Adherence to Dilated Eye Examination Recommendations Among Patients
  with Diabetes, Combined with Patient and Provider Perspectives
type: Article
unique-id: WOS:000390354300004
usage-count-last-180-days: '0'
usage-count-since-2013: '1'
volume: '9'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2016'