Bobeck Modjtahedi, MD, describes how Kaiser Permanente leveraged its telehealth resources to provide care to those with diabetic retinopathy (DR) throughout the COVID-19 pandemic.
COVID-19 presented an opportunity for health systems to rethink how they carry out some projects, said Bobeck Modjtahedi, MD, a vitreoretinal surgeon at Kaiser Permanente in Southern California. Modjtahedi’s talk, “Telehealth in Ocular Care for Diabetic Retinopathy Before and After COVID-19,” was presented at the American Diabetes Association's 81st Scientific Sessions.
Can you introduce yourself and give an overview of the work you do?
I'm Bobeck Modjtahedi, MD. I'm a vitreoretinal surgeon at Kaiser Permanente in Southern California. Additionally, I'm the director of our Eye Monitoring Center, which provides teleophthalmology services for patients in Southern California, as well as Georgia, Colorado, and Hawaii.
How did you conduct your research on telehealth use for diabetic retinopathy before and after COVID-19?
We already benefited from the fact that we have a robust telehealth system within our organization and were already doing hundreds of thousands of telehealth visits for diabetic retinopathy even before COVID-19. When COVID-19 came, this was kind of an opportunity to do a reset, and try to maybe rethink the way we do some of our projects. One of the things we tried to actively engage in, especially during the immediate COVID-19 period in March 2020, when we shut down screening, we took it as an opportunity to stop and think about how our programs work, and what ways to roll them out in better ways. We tried to do it proactively and prospectively, so to speak. Every time we tried to roll out slowly, we were constantly analyzing the data in real time to see how many patients we were screening, how many patients were needing additional referrals, what our missed opportunities were for screening. It was really, instead of a retrospective study that somebody thinks about and going through and hashing through the numbers after the fact, this is really something that we were doing, not even as a research project, but more as a clinical utilization work in real time, essentially. Month to month, we were analyzing our data. And again, not for the purposes of publishing a paper but to actually get real-time feedback on the performance, and then figuring out ways to improve what we were doing going forward for the immediate COVID-19 pandemic time and then also trying to restructure things to potentially be more efficient and meaningful going forward, once we're past the bigger surges.
What were some of the main findings?
What we have found actually, throughout many of our programs, even before COVID-19, is that patients really enjoy the telehealth experience, because it limits the amount of time they have to spend in the doctor's office, waiting around, getting their eyes dilated. It's a much more streamlined process. That's something that was essentially magnified during COVID-19. Patients want to limit their exposure to health care settings and the amount of time waiting around and seeing doctors and interacting with staff. This was something that was welcomed with a certain amount of enthusiasm from our patients.
This was also an opportunity to build out some of our additional programs. We've always done screening for a long time in primary care offices. One thing that we tried to build out more, which we had been doing before COVID-19, but this was an opportunity to leap forward with it, was more monitoring of more severe forms of retinopathy. What we had found was that many of the patients that had more severe forms of retinopathy that we were referring in to see a retina specialist didn't yet need treatment. Patients with moderate nonproliferative diabetic retinopathy, they were being sent in but still monitored in the clinic setting. We thought this was a good opportunity to build out our monitoring program to monitor more patients in the telehealth setting. So they would just come in, get some photographs, a wide field photograph of their retina and an ocular coherence tomography (OCT) of their macula, a high resolution scan of their macula. If those were abnormal, then they were subsequently sent in to see a retina specialist to initiate treatment. We have found a very high percentage, 80% to 90% of the patients who wanted screening fundus photographs, had moderate levels of damage, were being monitored anyways. That was something that we could just absorb inside of a telehealth screening, inside of our program. Those patients who have very severe forms of retinopathy are still being directly sent to see a retina specialist on the photograph. But those more moderate forms, we're trying to build out more and more systems to see them within a telehealth program essentially.