A retrospective analysis using administrative data of factors that impact access to vision care for patients with diabetes

Objectives: To describe the design and development of a 4-year retrospective database (2007-2010) that compiles electronic billing and medical chart information. This data is being used to study individual-level, clinical-level and system-level factors that impact access to and quality of vision care, evaluating adherence to dilated fundus exam (DFE) follow-up.

Methods: Four years of encounter level patient data were drawn from the Wills Eye Clinical Primary Eye Care (CPEC) and Retina Services. Patients with diabetes were first identified through the automated claims database. Additional clinical and other information were extracted from patient's chart in the CPEC and/or Retina Services. Data from automated claims files were enhanced by data elements obtained through chart review.

Results: 2,303 patients with 8,050 visits were identified over the 4-year period. 57% of patients were aged 40-60 years; 4.5% were 81+ years. Patients were classified according to their most severe diagnosis at each encounter. Of the index visits, 57.3% were for diabetes mellitus only (250.xx). Ocular co-morbidities included glaucoma (15.4%) and cataracts (48.5%). Baseline relationships between DFE follow-up adherence, and demographic, clinical, and SES factors were examined.

Conclusions: This project has established a data repository that provides an analytic foundation for the study of DFE follow-up as well as the basis for future investigations of other aspects of patient care. By utilizing retrospective data from two large, real-world, clinical services, we have the ability to identify different patterns of patient care and have laid the foundation for interventions which may be useful in these settings.