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Vision loss among diabetics in a group model Health Maintenance Organization (HMO).

Publication ,  Journal Article
Fong, DS; Sharza, M; Chen, W; Paschal, JF; Ariyasu, RG; Lee, PP
Published in: Am J Ophthalmol
February 2002

PURPOSE: To report the management of diabetic retinopathy in one group model health maintenance organization and assess the quality of care. METHODS: Cross-sectional study. A chart review of 1200 randomly identified patients with diabetes mellitus, continuously enrolled for 3 years in Kaiser Permanente (KP) Southern California, the largest provider of managed care in Southern California, was performed. A total of 1047 patients were included in the analyses. Patient characteristics as well as information from the last eye examination were abstracted. Charts from patients with visual acuity less than 20/200 in their better eye (legal blindness) were selected for extensive chart review to determine the cause of visual loss and the antecedent process of care. T tests or the Wilcoxon rank sum test was used to compare continuous variables. The chi(2) test or the Fisher exact test was used to compare categorical variables. All analyses were performed on the Statistical Analyses System (SAS Institute, North Carolina). RESULTS: Our study population of 1047 diabetic patients was 51.7% male, had a mean age of 60.4 years, a mean duration of diabetes of 9.6 years, and a mean hemoglobin A1c of 8.3%. During the study period, 77.5% of patients received a screening eye examination with examination by an ophthalmologist, an optometrist, or review of a retinal photograph. Of those with a visual acuity assessment (n = 687, 65.6% of 1047), 1.5% had visual acuity of 20/200 or worse (legally blind) in the better eye, while 8.2% had this level of visual acuity in the worse eye. Of eyes with new onset clinically significant macular edema and visual acuity < 20/40, 40% had documentation of focal laser performed within 1 month of diagnosis. Of eyes with vitreous hemorrhage and visual acuity < 20/40, 50% had documentation of vitrectomy. Among eyes that had vitrectomy, over 80% had this procedure within 1 year of diagnosis of vitreous hemorrhage. CONCLUSIONS: The current report is the largest study of diabetic retinopathy outcomes among patients enrolled in a prepaid health plan. Further research is necessary to investigate the impact of managed care on health outcomes.

Duke Scholars

Published In

Am J Ophthalmol

DOI

ISSN

0002-9394

Publication Date

February 2002

Volume

133

Issue

2

Start / End Page

236 / 241

Location

United States

Related Subject Headings

  • Vitrectomy
  • Visual Acuity
  • Quality of Health Care
  • Prevalence
  • Ophthalmology & Optometry
  • Middle Aged
  • Male
  • Laser Coagulation
  • Humans
  • Health Maintenance Organizations
 

Citation

APA
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ICMJE
MLA
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Fong, D. S., Sharza, M., Chen, W., Paschal, J. F., Ariyasu, R. G., & Lee, P. P. (2002). Vision loss among diabetics in a group model Health Maintenance Organization (HMO). Am J Ophthalmol, 133(2), 236–241. https://doi.org/10.1016/s0002-9394(01)01364-2
Fong, Donald S., Mohktar Sharza, Wansu Chen, John F. Paschal, Reginald G. Ariyasu, and Paul P. Lee. “Vision loss among diabetics in a group model Health Maintenance Organization (HMO).Am J Ophthalmol 133, no. 2 (February 2002): 236–41. https://doi.org/10.1016/s0002-9394(01)01364-2.
Fong DS, Sharza M, Chen W, Paschal JF, Ariyasu RG, Lee PP. Vision loss among diabetics in a group model Health Maintenance Organization (HMO). Am J Ophthalmol. 2002 Feb;133(2):236–41.
Fong, Donald S., et al. “Vision loss among diabetics in a group model Health Maintenance Organization (HMO).Am J Ophthalmol, vol. 133, no. 2, Feb. 2002, pp. 236–41. Pubmed, doi:10.1016/s0002-9394(01)01364-2.
Fong DS, Sharza M, Chen W, Paschal JF, Ariyasu RG, Lee PP. Vision loss among diabetics in a group model Health Maintenance Organization (HMO). Am J Ophthalmol. 2002 Feb;133(2):236–241.
Journal cover image

Published In

Am J Ophthalmol

DOI

ISSN

0002-9394

Publication Date

February 2002

Volume

133

Issue

2

Start / End Page

236 / 241

Location

United States

Related Subject Headings

  • Vitrectomy
  • Visual Acuity
  • Quality of Health Care
  • Prevalence
  • Ophthalmology & Optometry
  • Middle Aged
  • Male
  • Laser Coagulation
  • Humans
  • Health Maintenance Organizations