{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:52:29Z","timestamp":1788504749340,"version":"build-2803163510"},"reference-count":31,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Telemedicine and e-Health"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Teleophthalmology is a validated method for diabetic eye screening that is underutilized in U.S. primary care clinics. Even when made available to patients, its long-term effectiveness for increasing screening rates is often limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>We hypothesized that a stakeholder-based implementation program could increase teleophthalmology use and sustain improvements in diabetic eye screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">We used the<\/jats:italic>\n                      NIATx Model\n                      <jats:italic toggle=\"yes\">to test a stakeholder-based teleophthalmology implementation program, I-SITE at one primary care clinic (Main) and compared teleophthalmology use and diabetic eye screening rates with those of other primary care clinics (Outreach) within a U.S. multipayer health system where teleophthalmology was underutilized.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Teleophthalmology use increased post-I-SITE implementation (odds ratio [OR]\u2009=\u20095.73 [<\/jats:italic>\n                      p\n                      <jats:italic toggle=\"yes\">&lt; 0.001]), and was greater at the Main than at the Outreach clinics (OR\u2009=\u200910.0 vs. 1.69,<\/jats:italic>\n                      p\n                      <jats:italic toggle=\"yes\">&lt; 0.001). Overall diabetic eye screening rates maintained an increase from 47.4% at baseline to 60.2% and 64.1% at 1 and 2 years post-I-SITE implementation, respectively (<\/jats:italic>\n                      p\n                      <jats:italic toggle=\"yes\">&lt; 0.001). Patients who were younger (OR\u2009=\u20090.98 per year of age,<\/jats:italic>\n                      p\n                      <jats:italic toggle=\"yes\">\u2009=\u20090.02) and men (OR\u2009=\u20091.98,<\/jats:italic>\n                      p\n                      <jats:italic toggle=\"yes\">\u2009=\u20090.002) were more likely to use teleophthalmology than in-person dilated eye examinations for diabetic eye screening.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Our stakeholder-based implementation program achieved a significant increase in overall teleophthalmology use and maintained increased post-teleophthalmology diabetic eye screening rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Stakeholder-based implementation may increase the long-term reach and effectiveness of teleophthalmology to reduce vision loss from diabetes. Our approach may improve integration of telehealth interventions into primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/tmj.2020.0270","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T13:53:43Z","timestamp":1605880423000},"page":"1021-1028","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Sustaining Gains in Diabetic Eye Screening: Outcomes from a Stakeholder-Based Implementation Program for Teleophthalmology in Primary Care"],"prefix":"10.1177","volume":"27","author":[{"given":"Yao","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia N.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Torres Diaz","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loren J.","family":"Lock","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Zupan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd D.","family":"Molfenter","sequence":"additional","affiliation":[{"name":"Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane E.","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Palta","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."},{"name":"Department of Biostatistics and Medical Informatics, and University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deanne","family":"Boss","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy D.","family":"Bjelland","sequence":"additional","affiliation":[{"name":"Mile Bluff Medical Center, Mauston, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen A.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."},{"name":"Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,9,6]]},"reference":[{"key":"e_1_3_5_2_2","unstructured":"Centers for Disease Control and Prevention. 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Available at https:\/\/www.cms.gov\/Medicare\/Medicare-General-Information\/Telehealth\/Telehealth-Codes (last accessed on May26 2020)."},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2015.1"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2018.6912"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.0204"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2017.1150"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8510(03)00050-2"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-022594"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-3427-9"},{"key":"e_1_3_5_19_2","unstructured":"Centers for Healthcare Enhancement Systems Studies. What is NIATx? Available at https:\/\/www.niatx.net\/what-is-niatx\/ (last accessed on June30 2020)."},{"key":"e_1_3_5_20_2","unstructured":"County Health Ranking Roadmaps. Juneau County Demographics. Available at https:\/\/www.countyhealthrankings.org\/app\/wisconsin\/2019\/rankings\/juneau\/county\/outcomes\/overall\/snapshot (last accessed on February28 2020)."},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1089\/tmj.2011.0075"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-019-0876-4"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.09-4512"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/11.5.407"},{"key":"e_1_3_5_25_2","doi-asserted-by":"crossref","unstructured":"Flaxel CJ Bailey ST Fawzi A Lim JI Adelman RA Vemulakonda A Ying G-S. Diabetic retinopathy Preferred Practice Pattern 2019. 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