DR care consistency may be lacking, according to a recent study.

DR care consistency may be lacking, according to a recent study. Photo: Jay Haynie, OD. Click image to enlarge.

In an effort to develop a novel methodology to identify lapses in diabetic retinopathy (DR) care in electronic health records (EHR) and evaluate health disparities by race and ethnicity, researchers recently found that three in four patients experience a lapse in DR care, with higher rates among non-Hispanic Black and Hispanic patients.

The retrospective cohort study included 39,561 adult diabetes patients (average age: 61.4) with 91,104 office visits who were evaluated at the Wilmer Eye Institute from January 1, 2013, to April 2, 2022. The methodology evaluating lapses in care first identified DR screening or treatment visits and then compared the providers’ recommended follow-up timeframe with the patient’s actual time to next encounter. The association of race and ethnicity with odds of lapses in care was evaluated using a mixed effects logistic regression model controlling for age, sex, insurance, severity of DR, presence of other retinal disorders and glaucoma.

The methodology to identify DR-related visits had a 95.0% sensitivity and 98.8% specificity as compared with a gold standard grader. The methodology resulted in a 97.3% sensitivity and 98.1% specificity for detecting a follow-up recommendation, with an average error of -0.05 weeks in extracting the precise timeframe. More than three in four (77.6%) patients had a lapse in care. In multivariable analysis, non-Hispanic Black patients had 1.24 odds and Hispanic patients had 1.26 odds of ever having a lapse in care compared with non-Hispanic white patients.

“Deploying this methodology in the EHR is one potential means by which to identify and mitigate lapses in critical ophthalmic care in patients with diabetes,” the study authors concluded in their paper.

Cai CX, Tran D, Tang T, et al. Health disparities in lapses in diabetic retinopathy care. Ophthalmology. March 3, 2023. [Epub ahead of print].