Project Open - Use of Administrative Health Data to Increase Diabetic Retinopathy Screening

March 26, 2025 updated by: Michael Brent, University Health Network, Toronto

Guiding Primary Care Diabetic Retinopathy Screening in Canada Through the Use of Provincial Healthcare Administrative Data

Early detection through regular diabetic retinopathy screening (DRS) is an effective method of preventing vision loss by enabling earlier intervention and timely treatment. It is recommended that all people with diabetes receive regular DRS, either annually or bi-annually. Current DRS practice in Canada, however, falls remarkably short of recommended DRS rates resulting in preventable vision loss.

In this project the investigators use population health-based approach to diabetes care. Linked provincial administrative data will be leveraged to consistently identify all those that have not had DRS in 425 days with the goal to improve outcomes, equity and potentially reduce the cost of care delivery.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Enrolling by invitation

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Detailed Description

Diabetic Retinopathy (DR) is the leading cause of blindness in working age Canadians. Canada fall remarkably short of this recommended rate resulting in many Canadians with preventable vision loss, despite the availability of ophthalmology and/or optometry services covered by provincial health insurance plans. It is estimated that in Ontario alone that up to 40% of individuals with diabetes have not had their eyes screened for retinopathy. To address the low rate, tele-ophthalmology or Tele-Retina, using telemedicine resources, has been an approach used in a variety of primary health care settings in urban, rural and remote areas across Canada. In the United Kingdom, a population-based approach to this issue have been taken and have lowered the unscreened rate, resulting in diabetic retinopathy no longer being the leading cause of blindness in working age individuals. New strategies are required to identify, engage, and provide ongoing monitoring to those requiring DR screening in Ontario.

The electronic medical records in doctors' offices do not receive information about the status of patients with diabetes retinopathy screening status. This information only exists through provincial data and public insurance system billings. Using administrative health data, the investigators developed a population-based approach to DR screening at community health centres (CHCs). Patients with diabetes who have not had DR screening in 425 days have been identified using linked provincial and community-based datasets.

Through the linking of the Alliance for Healthier Communities dataset with other Ontario healthcare administrative databases held at Institute for Clinical Evaluative Sciences (IC/ES), the investigators have identified clients within the CHC that have not had eyes checked for signs of retinopathy by an ophthalmologist or optometrist within the previous 425 days. This data is transferred to the CHC and the identified clients will then be called to let them know about the importance of having their eyes examined and to see if they are interested in participating in the study. Through the Diabetes Eye Screening Program, Tele-Retina will be made available through referral. If individuals are not interested in this program, patients will be encouraged to seek alternate ophthalmology or optometry services.

Qualitative semi-structured interviews examining diabetic retinopathy screening and the Tele-Retina process at the CHC, including facilitators and barriers towards diabetes care, specifically eye care, will be conducted. The investigators will be interviewing patients, caregivers, healthcare practitioners, CHC staff, management and policy decision-makers.

The intervention of providing provincial-level diabetic retinopathy status to primary health care settings will be evaluated using a mixed-methods implementation-effectiveness hybrid approach. Evaluation will be conducted concurrently with the study intervention to evaluate its effectiveness, cost-effectiveness, implementation barriers and key success factors. The evaluation will consist of 4 main components of 1) an implementation study, 2) a policy study, 3) clinical evaluation and 4) economic evaluation studies.

Our overall objectives for the study are to:

  1. Increase the number of screened individuals who are at risk for DR within the primary care settings, and to refer to treatment those at risk of vision loss;
  2. Evaluate implementation and policy barriers associated with the transfer and use of healthcare administrative data related to DR, at a primary care level and DR screening in general;
  3. Evaluate patient and provider experience and attitudes with the initiative, including sex and gender and socioeconomic factors;
  4. Describe the severity of diabetic retinopathy in those individuals who agree to be screened;
  5. Examine the healthcare resource utilization and costs and cost-effectiveness associated with the intervention.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
2000

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Ontarioa
      • Toronto, Ontarioa, Canada, M5T 2S8
        • University Health Network

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

patients with type 1 or type 2 diabetes, who have attended a primary healthcare setting at CHCs, and through the use of provincial administrative data is identified as the patient who has not had their eyes screened within the past 425 days.

Description

Inclusion Criteria:

  1. At least 18 years of age
  2. Type 1 or type 2 diabetes as determined through linked provincial healthcare administrative datasets or primary care data using algorithms similar to provincial methods.
  3. Attended the primary health care setting, with at least 1 visit to the centre within the past 10 years

Exclusion Criteria:

1. Individuals identified as having received DRS (in the previous 425 days) by an ophthalmologist and/or optometrist or tele-ophthalmology/Tele-Retina.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
The provision of a DRS status list to primary health care settings will increase the rate of annual DR screening in patients with type 1 or type 2 diabetes who have attended the centres.
Time Frame: 425 days
To increase the screening rate of individuals who are at risk for DR within the primary care settings, and to refer to treatment those at risk of vision loss.
425 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University Health Network, Toronto

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Institute for Clinical Evaluative Sciences
South Riverdale Community Health Centre
Flemingdon Health Centre

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
February 1, 2022

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 31, 2025

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 31, 2025

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 29, 2021

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 29, 2021

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 12, 2021

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
April 1, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
March 26, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
March 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 8 Sep 2020

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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