A quality improvement initiative increased diabetic eye exam screening rates from 32.6% to 42.8% at one site, but did not improve rates at a second site.
Does a quality improvement initiative improve diabetic eye exam screening rates in patients with diabetes?
A quality improvement initiative utilizing proactive outreach and team-based care improved diabetic eye screening rates in a safety-net healthcare system, whereas EHR reminders alone in a primary care clinic did not.
Absolute Event Rate: 42.8% vs 32.6%
Introduction and Objective: Diabetic retinopathy is the leading cause of blindness among working-age adults in the United States. Despite evidence-based guidelines for regular screening for diabetic eye disease, screening rates remain suboptimal. This quality improvement initiative aimed to improve screening rates for diabetic eye disease at two practice sites. Methods: We worked with two sites in Jefferson County, AL, a safety-net healthcare system and an academic primary care practice. We began working with Site 1 in 2023 and Site 2 in 2024; the project is ongoing with data through end of 2025. We used practice facilitation to implement strategies to improve diabetic eye exam screening. Both sites used standardized reporting/tracking of screening rates and diabetic eye exam reminder cards. Site 1 used proactive outreach to patients due for screening, removed the requirement for a referral order, and reviewed status as part of team-based care. Site 2 used EHR reminders for patients due for screening. Our primary outcome measure was diabetic eye exam screening rates applying the HEDIS measure, generating monthly-quarterly reports through the electronic health record. We used process measures of eye clinic appointments scheduled for patients with diabetes (Site 1) and referrals for diabetic eye exam (Site 2). We tracked screening rates over time using run charts. Results: Site 1 serves 2002 patients with diabetes who were recommended to receive a diabetic eye exam; at site 2, this population was 1375. Site 1 screening rates increased from 32.6% for first quarter of 2024 to 42.8% last quarter in 2025, representing almost 300 additional patients who were up to date on screening. At site 2, we did not see improvement in screening rates from 2024 to 2025. Conclusion: There is significant room for improvement in diabetic eye screening rates in a safety-net healthcare system and primary care clinic. This quality improvement initiative led to increased screening rates at one site, highlighting the role of standardized care processes and team-based care to achieving improved screening rates. Disclosure M.M. Craft: None. C. Presley: None. Funding This work was funded through a partnership with the American Diabetes Association (ADA) and Genentech, a member of the Roche Group, as part of the ADA’s Health Access work.
Craft et al. (Fri,) conducted a other in Diabetes (n=3,377). Quality improvement initiative vs. Baseline was evaluated on Diabetic eye exam screening rates applying the HEDIS measure. A quality improvement initiative increased diabetic eye exam screening rates from 32.6% to 42.8% at one site, but did not improve rates at a second site.