Short‐Term Outcomes of Two Interventions for Patients With Active Proliferative Diabetic Retinopathy in an Urban, Safety‐Net Hospital

ABSTRACT Background Proliferative diabetic retinopathy carries significant visual morbidity and loss to follow‐up can lead to poorer visual outcomes. This study aims to evaluate the short‐term impact of two systems‐focused clinical initiatives directed toward reducing loss‐to‐follow‐up and increasing pan‐retinal photocoagulation (PRP) rates in patients with active proliferative diabetic retinopathy (PDR) in an urban, safety‐net, teaching‐hospital setting. The introduction of an additional weekly PRP clinic was followed by the creation of an active PDR patient registry with an appointment reminder system. Methods This was a single‐center, observational, retrospective cohort study between December 2022 and May 2024. We established three cohorts of encounters based on the number of eyes with active PDR in sequential order: historical controls (115 encounters) in the 8 months preceding the first intervention, increased provider PRP volume (74 encounters) over the next 4 months, and patient registry with an appointment reminder system in addition to increased provider PRP volume (65 encounters) for the following 4 months. We used linear and generalized linear mixed‐effects models clustered at the patient level. Short‐term process measures included the number of monthly PRP clinics, time to PRP after referral, rates of PRP and full PRP, PRP clinic adherence rate, 3‐month ophthalmology clinic adherence rate, and 3‐month loss‐to‐follow‐up rate. Results The introduction of an additional weekly PRP clinic was associated with a decrease in time from referral to PRP by 37 days ( p < 0.001), increased odds of 3‐month PRP (odds ratio [OR]: 6.53; 95% confidence interval [CI]: 3.03–14.10; p < 0.001) and 3‐month full PRP (OR: 4.66; 95% CI: 2.22–9.78; p < 0.001). Subsequent introduction of a patient registry/appointment reminder system was associated with decreased odds of 3‐month loss‐to‐follow‐up (OR: 0.10; 95% CI: 0.01–0.79; p < 0.05) compared to historical cohort and improved odds of 3‐month ophthalmology clinic adherence (OR: 2.96; 95% CI: 1.18–7.47; p < 0.05) compared to the increased PRP clinic cohort. Conclusions Dedicating additional clinic time for PRP and introducing a high‐risk registry and reminder system were associated with improved access to care, reduced loss‐to‐follow‐up, and increased overall clinic adherence in an urban, safety‐net hospital system. Long‐term visual and functional outcomes of these initiatives are an essential area of future study.