Assessing diabetic retinopathy burden and treatment at underserved and academic medical center settings using multi-center electronic medical record data

purpose: Diabetes is the leading cause of blindness among United States adults 40 years and older. Diabetes and diabetic complication rates have been shown to be higher in medically underserved and low-income populations. Gaining insight into the vision care of this population will provide a basis for better management.

methods: The HealthLNK database was used to identify 1,933,082 unique patients who visited a participating institution from 2006-2012. HealthLNK includes electronic medical record (EMR) data from 6 federally qualified health centers (FQHCs), and 6 hospitals, including 4 academic medical centers in Chicago. Diabetic patients were defined by ICD-9 codes for diabetes and/or diabetic complications. From this population, patients with diabetic retinopathy codes were elucidated. Diabetic retinopathy patients with CPT codes related to diabetic retinopathy treatment were further categorized. Insurance status was also determined within each subgroup.

results: Of the 1,933,082 patients in the HealthLNK database, 171,427 were identified as diabetics (prevalence of 8.9%). 12,014 patients had diabetic retinopathy (7.0% of diabetics). 2,143 patients had CPT codes related to diabetic retinopathy treatment (17.8% of retinopathy patients). There were differences in the prevalence of diabetic retinopathy in diabetics (5.7% vs. 9.0%, p<0.01) and subsequent treatment (15.4% vs. 20.2%, p<0.01) when comparing "Medicaid/Financial Means Tested/Uninsured" vs. "Medicare/Privately Insured" patients.

conclusions: The prevalence of diabetic retinopathy and procedures varied by insurance status, suggesting screening and treatment disparities may exist. Future work will elucidate the significance and reasons for these differences. This study also demonstrates the effectiveness of using multi-center EMR data to identify healthcare disparities.