Date of Award
Summer 5-24-2025
Document Type
Doctor of Nursing Practice Final Manuscript
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Scot Nolan, DNP, RN, CNS, PHN, CCRN, CNRN, SCRN, FCNS
Second Advisor
Deborah Monson, PHD, ACNS-BC, PHN
Abstract
Abstract
Utilizing a Clinical Resource Hub to Improve Access and Workflow for Retinal Screenings in the Veteran Population
Erin K. Pope, MSN, RN, AGCNS-BC, AMB-BC
Scot Nolan, DNP, RN, CNS, PHN, CCRN, CNRN, SCRN, FCNS
Background: Diabetic retinopathy (DR), a progressive complication of diabetes mellitus (DM), is the leading cause of blindness among working-age adults. As DR can remain asymptomatic until advanced stages, annual screenings are critical for early detection and management. Teleretinal imaging is an evidence-based method for DR screening, offering cost efficiency and reduced demand on ophthalmology clinics. At the Veterans Administration’s (VA) Loma Linda Healthcare System (VALLHS), 88% of DR screenings were performed in-person at ophthalmology clinics, despite the availability of teleretinal technology in primary care clinics. Teleretinal screenings are significantly more cost-effective and improve patient compliance by aligning with primary care appointments. In 2019, the Veterans Health Administration (VHA) introduced clinical resource hubs (CRHs) to streamline services and alleviate demand, including a TeleEye CRH for teleretinal image interpretation.
Project Purpose: This project sought to enhance access to DR screenings, reduce screening costs, and alleviate demand on the ophthalmology clinic by integrating a teleretinal screening program into primary care clinics at VALLHS, utilizing a TeleEye CRH.
EBP Model/Framework: The VA Quality Enhancement Research Initiative (QUERI) guided evidence-based practice implementation.
Evidence-Based Intervention: Primary care clinic staff were trained to use the Eye-At-Risk clinical reminder tool to identify eligible veterans for screenings. Consults for screenings were placed and schedulers coordinated appointments to align with primary care visits. Teleretinal images were analyzed asynchronously utilizing a TeleEye CRH for image interpretation.
Implications for Practice: Integrating teleretinal screenings into primary care reduces the burden on ophthalmology clinics, lowers costs and enhances veterans' access by providing screenings within primary care settings.
Conclusion: Implementing a teleretinal screening program supported by a TeleEye CRH reduced screening costs by 37.5%, improved screening access by 257%, and decreased the number of veterans referred to non-VA providers in FY2024 by 525.
Keywords: Diabetic retinopathy (DR), blindness prevention, TeleEye program, Clinical Resource Hub (CRH)
Digital USD Citation
Pope, Erin Kelly, "Utilizing a Clinical Resource Hub to Improve Access and Workflow for Retinopathy Screenings in the Veteran Population" (2025). Doctor of Nursing Practice Final Manuscripts. 304.
https://digital.sandiego.edu/dnp/304
Copyright
Copyright held by the author
Included in
Community Health and Preventive Medicine Commons, Eye Diseases Commons, Nursing Commons, Telemedicine Commons
