Project Summary/Abstract There are several gaps in our understanding of the population with diabetic retinopathy (DR) that is not being screened and how best to manage those at high-risk for DR. Continued existence of these gaps underlies the difficulty in addressing the long-term goal of the proposed research program: to decrease preventable blindness from DR. The overall objective of this proposal is to design a patient navigator intervention for those at high-risk for DR informed by a national analysis of undiagnosed DR. The central hypothesis is that the candidate can create a feasible and acceptable program to increase utilization of eye care in those at high-risk for DR. The rationale for the hypothesis is that engaging high-risk patients with diabetes in eye screening will facilitate earlier treatment of DR and decrease preventable blindness. The proposal features a multi-method approach to determine the prevalence and the individual and neighborhood level characteristics of undiagnosed DR, and a patient navigation program pilot study for those at high-risk for DR. The candidate will reach the overall objective by pursuing the following two specific aims: 1) Determine national prevalence of undiagnosed DR with a focus on racial and ethnic disparities and geospatial variation; and 2) design and pilot a patient navigator program for those at high-risk for DR. For the first aim, a representative sample of the US population will be evaluated using the National Health and Nutrition Examination Survey, 2005-2008. Participants who underwent fundus photography and were diagnosed with DR based on software-assisted image grading will be included in the analysis. Those who reported a prior diagnosis of DR in an in-home interview will be compared to those that did not report a diagnosis of DR. For aim two, the Tailored Implementation for Chronic Disease implementation science framework will inform the design of the program. First, we will conduct semi-structured interviews with local community members with diabetes who have not had an eye exam within 1 year. Second, the determinants identified during the interviews and in the first aim will be applied to the framework. Third, determinants will be prioritized and a multidisciplinary team of stakeholders will design of the program. Fourth, sixty participants will be recruited from a population with diabetes stratified by eye care utilization and risk based on data from the institutional electronic medical record. The program will include an individual patient navigator assessment, a clinical evaluation, an educational experience, and patient navigator follow-up. This approach is innovative because it identifies the population with undiagnosed DR, uses a risk calculator to identify those at high risk for DR, and employs a patient navigator-based program to improve screening for those at high risk for DR. This study is significant because it investigates the gap between published guidelines and the popula...