# I-TRUST: Implementation of Teleophthalmology in Rural Health Systems Study

> **NIH NIH UG1** · UNIVERSITY OF WISCONSIN-MADISON · 2022 · $1,119,492

## Abstract

PROJECT SUMMARY/ABSTRACT
 Among working-age U.S. adults, diabetic retinopathy remains the leading cause of blindness despite
landmark National Eye Institute (NEI) clinical trials showing that early detection and treatment reduce the risk of
severe vision loss by over 90%. Yet adherence with yearly diabetic retinopathy screening in the U.S remains
below half of patients in rural communities. Ocular telemedicine (i.e. teleophthalmology) can substantially
increase diabetic retinopathy screening rates and prevent blindness. However, there is often very limited use of
this technology even after a teleophthalmology program is established in multi-payer health systems, where the
majority of Americans receive their care. To overcome major barriers identified for teleophthalmology use in rural
multi-payer primary care clinics, the PI developed and piloted Implementation to Sustain Impact in
Teleophthalmology (I-SITE) in a NEI K23 Career Development Award. I-SITE is the first implementation program
specifically designed to overcome barriers to teleophthalmology use by tailoring its integration into rural primary
care clinic workflows. The proposed study is a multi-center randomized controlled trial aiming to: (1) test the
effectiveness of I-SITE, (2) identify explanatory factors and implementation components that distinguish high
and low teleophthalmology use in rural health systems following I-SITE implementation, and (3) evaluate
implementation costs. We hypothesize that I-SITE will sustain significant diabetic eye screening rate increases
at 18 months compared to usual care teleophthalmology.
 This UG1 proposal directly responds to multiple elements of the NEI Strategic Plan, including areas of
emphasis in telemedicine, diabetic retinopathy, and expanding access to eye care in rural populations. This
research will facilitate the effective translation of telemedicine technology in rural multi-payer primary care clinics
to improve diabetic retinopathy screening rates. The effective integration and scale-up of ocular telemedicine
would greatly expand eye care access for millions of rural Americans. This will be critical for preventing avoidable
blindness by overcoming the shortage of eye care providers and meeting the increased demand for eye
screening resulting from major projected increases in diabetes prevalence. As we face
unprecedented challenges to our nation's health systems, never before in our history has the need for a
rapid transition to telehealth been more acute. Our study will provide vital knowledge regarding the
methods and factors needed to successfully translate telehealth technology into widespread clinical
practice for improving public health nationwide.

## Key facts

- **NIH application ID:** 10488178
- **Project number:** 5UG1EY032446-02
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** Yao Liu
- **Activity code:** UG1 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $1,119,492
- **Award type:** 5
- **Project period:** 2021-09-30 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10488178

## Citation

> US National Institutes of Health, RePORTER application 10488178, I-TRUST: Implementation of Teleophthalmology in Rural Health Systems Study (5UG1EY032446-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10488178. Licensed CC0.

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