# Improving linkage to care after ocular telehealth screening in diabetic adults

> **NIH NIH P20** · UNIVERSITY OF VERMONT & ST AGRIC COLLEGE · 2020 · $256,101

## Abstract

Diabetic retinopathy (DR) is the leading cause of vision loss in working-aged Americans. Because of the 
increasing prevalence of diabetes mellitus, the absolute number and proportion of people affected by DR is 
predicted to increase dramatically in the coming years. Fortunately, when detected early through screening, 
and therapy is appropriately initiated, vision loss from DR is largely preventable, and for this reason, annual 
dilated eye exams are recommended for most people with diabetes. Historically, adherence to recommended 
screening has been poor, with 45-65% of eligible patients receiving appropriate screening. Because of these 
observations, access to high quality screening has been improved with innovative remote detection programs 
using ocular telehealth that allow for retinal photographs to be taken in the primary care setting. This has 
been of particular value for rural and socioeconomically disadvantaged populations with poor access to 
subspecialty care. Unfortunately, several studies have demonstrated that linkage to care for diagnostic 
examination and effective therapeutic intervention has been quite poor following successful remote detection 
of DR. Indeed, the success of the screening has unmasked a problem that threatens the public health 
achievement of improved screening; the very people most likely to benefit from the increased convenience 
of ocular telehealth may be the least likely to link to ophthalmic care when needed, i.e., people with poor 
physical access to care and low socioeconomic status. In the present study, we seek to determine whether 
providing financial incentive will improve rates of linkage to ophthalmic care. Financial incentives have been 
proven to be highly effective in improving other health behaviors among disadvantaged populations (e.g., 
substance abstinence, smoking during pregnancy, weight loss, etc). For this study, we will randomize 62 lowincome 
adults with diabetes mellitus and suspected DR based on ocular telehealth screening to a treatment 
condition in which participants receive financial incentives contingent upon linkage to care or to a usual-care 
condition in which they will receive education about DR. The primary outcome will be successful linkage to 
care with a with a qualified ophthalmic provider. Cost effectiveness of the intervention will also be examined 
by comparing the costs of the incentive intervention with its effects on increasing linkage to care.

## Key facts

- **NIH application ID:** 10228855
- **Project number:** 5P20GM103644-08
- **Recipient organization:** UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
- **Principal Investigator:** Christopher John Brady
- **Activity code:** P20 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $256,101
- **Award type:** 5
- **Project period:** 2018-09-01 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10228855

## Citation

> US National Institutes of Health, RePORTER application 10228855, Improving linkage to care after ocular telehealth screening in diabetic adults (5P20GM103644-08). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10228855. Licensed CC0.

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