Access and Analysis of Provincial Administrative Data for Cohort Disclosure to Guide Community-Based Diabetic Retinopathy Screening

#Background 

It is recommended that individuals living with diabetes have their eyes examined for signs of retinopathy annually. Even with access to eye care resources across Canada, including tele-ophthalmology, many individuals with diabetes remain unscreened with screening rates lowest in vulnerable populations. A population-based approach to identify, engage, and provide screening is needed. 

#Methodology

Linked provincial administrative datasets were used to identify clients with diabetes receiving care from community health centres (CHC) who have not had diabetic retinopathy (DR) screening within the previous 425 days by an optometrist, ophthalmologist or other practitioners. Datasets included the Ontario Diabetes Dataset (ODD), Registered Persons Database, Ontario Health Insurance Plan Claims Database and Alliance for Healthier Communities e Business Intelligence and Reporting Tool (BIRT) CHC data. CHC practitioner diabetes diagnosis, provincial insurance coverage, and eye examination status were evaluated. 

#Results

Across the 3 participating CHCs, 6,032 individuals were identified as living with diabetes, with 536 (8.9%) solely identified within CHC data in the initial analysis. For those with provincial health insurance attending the CHC, 3,568/5,131 (69.5%) had at least one eye exam in the previous year. Cohort disclosure and privacy review processes have been completed. 

#Conclusions

Utilization of both provincial and community-based datasets is required to fully identify those in need of screening as vulnerable individuals may not be enrolled with provincial health coverage. A population-based approach to timely guideline-recommended retinopathy screening for those in need could be expanded to develop a national registry, supporting the management of diabetes complications and chronic disease.