The Use of Quality Improvement Continuing Medical Education to Improve the Evaluation of Diabetic Retinopathy

Rationale: Diabetic Retinopathy (DR) is a leading cause of vision loss worldwide. While regular screening can lead to earlier interventions, reduce vision loss, and improve patient outcomes, baseline screening in patients at risk for DR has traditionally been low. Methods: To improve screening rates for DR, Vindico Medical Education and staff from the Cole Eye Institute at the Cleveland Clinic (CC) developed and executed a quality improvement CME (QI-CME) initiative within a closed network of endocrinologists and primary care physicians (PCPs) who see patients with diabetes. Interventions included a series of live, print, and web-based CME activities focused on the timely referral of patients with diabetes for ophthalmic evaluation. Results: At baseline, 95.5% and 71% of endocrinologists and PCPs, respectively, asked their patients about ophthalmologic signs and symptoms, though there was significant delay in the time between initial patient visit and follow-up with ophthalmology among the providers (173.2 days for endocrinologists and 184.8 days for PCPs). After delivery of the QI-CME within the closed system, there were significant gains in knowledge and competence as well as a 125-day and 130-day reduction in time between initial patient visit and ophthalmology follow-up, among endocrinologists and PCPs, respectively. Conclusion: This program demonstrated that the sequential delivery of targeted CME coupled with patient chart reviews within a closed health system is a relatively simplistic, yet powerful model to address this practice gap toward improved patient outcomes by avoided vision loss. Notably, this model may be easily adopted to engage additional pertinent audiences, such as ophthalmologists, or to different therapeutic areas that rely on timely referral to a specialist for appropriate care. Disclosure K. Robinson: None. R.A. Esgro: None.