Transcript Dorset Diabetic Eye Screening Programme 2009 Update

Dorset Diabetic Eye Screening
Programme
2010 Update
Dr Wendy Gatling
Clinical Director DDESP
DDESP 2010 Update
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Annual Statistics
Ungradeable & pupil dilatation
Current Referral Pathway
Web based Grading Exercise
SLB & SLEs
DDESP Structure
March 2010
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45 optical practices (29 offer SLB)
Swanage + DCH hospital clinics
RBH + PHT monitoring clinics
Grading: 44 optometrists (4 on leave+1
suspended+3 due to stop end March) + 4
hospital graders
• Capture only:12 screeners (1suspended)
DDESP
7.9.09 Snapshot
Sept 09 Dec 09
Programme size
28,504 (33,505)
Eligible for screening
25,468 (29,957)
Excluded
425 (1.5%)
Opted out
133 (0.5%)
Community SLB
1198
Hospital SLB
196
Ophthalmology
2,065 (7.2%)
April 2010 EQA review standard >2% excluded
considered unsafe
Annual Report 2008/9
• Digital screening 22,599 patients [26,006 tests]
• SLB examinations 1,496 by optometrists
• Attended screening ~ 89%
Optical Practice Activity (from Orion payments)
Capture
21,838
Grading
20,252
Concurrent SLB
1,273 **
Separate SLB
223
Grading Results
• Proliferative R3
• Pre-proliferative R2
• Maculopathy M1
237 patients
183 patients
840 patients
• Required SLB
528 patients
• Referred to ophthalmology 293 patients in
6 months [projected 586 for 1 year]
Prevalence of any retinopathy
Annual Report 08/09
All images graded 23,494
Any retinopathy detected 7,283 (31%)
Prevalence of Any Retinopathy in Digital Imaging in DDESP
40
35
30
Per Cent
25
20
Any retinopathy%*
15
10
5
0
01/10/2005- 01/10/2006- 01/04/2007- 01/10/2007- 01/04/2008- 01/10/2008- 01/04/200931/03/2006 31/03/2007 30/09/2007 31/03/2008 30/09/2008 31/03/2009 31/08/2009
Half Year Period
Prevalence of any retinopathy April-Dec 09
33%
Ungradeable Rate
Orion report 2008/9
213 unassessable
1070 unobtainable
Total 4.4%
Orion report April-Dec 09
325 unassesable
941 unobtainable
Total 6.5%
How to Use Orion for SLB grading
Reducing Ungradeable Images
New pupil dilation protocol
1% tropicamide 1 drop each eye
Repeat after 15 minutes
Inadequate dilation at 30 minutes
2.5% phenylephrine [STOCK ITEM]
Patient notes – use 2 mydriatics
DDESP Referral Pathway
• All patients with any retinopathy or
unassessable go to second disease grade
• All R2, R3 or M1 potentially referable to
MDT
• New protocols for R3.2 or R3.3
• New protocol for M1 with reduced VA and
dots or haemorrhages only
DDESP weekly MDTs
January to June 09
About 33 patients per week
Total patients reviewed
855
Referred to Hospital Eye
Service (HES)
269
% referred to HES
31%
Returned to screening
588
% returned to screening
69%
Patients Treated for DR
Screening to treatment time audit
Oct 08-March 09
67 patients
All patients treated by laser
April 08 to March 09 RBH & PHT
198
Oct 08 to March 09 RBH, PHT & DCH 238
NB Estimate 23% of patients receiving laser come
after first HES from DDESP
Web based Grading Exercise
ending Dec 2009
• 42 of 43 eligible graders and 1 capture
technician participated
• Good results overall
• 20 graders suggested grading session –
individual and group sessions
NEXT EXERCISE OPEN
• 50 imagesets by end of May 2010
DDESP & EQA grading tests
new targets
Test type
Minimum score
No of tests per 6month period
Dorset web test (50
questions per test set)
80% sensitivity for sight
threatening retinopathy
1
National DRSEQA test
set (30 questions per
test set)
80% overall score
2
Score
Result
target
Interpretation of achieving target
Sensitivity for STR
> 90%
Low under grading Missing less than
1 in 10 patients with STR
Sensitivity for any
retinopathy
> 95%
Low under grading
Missing less than 1 in 20 patients with
any retinopathy
Specificity for STR
95%
Low over grading
Correctly grading 19 of 20 patients as
not having STR
Specificity for any
retinopathy
75%
Low over grading
Correctly grading 15 of 20 patients as
having no retinopathy
National EQA test sets
DDESP
53 graders
31% logged on
New feature
Welcome to the online EQA system
View history
Level
No. times
answered correctly
% times
answered correctly
30
20
67 %
1
R0
0
0
0%
0
R1
17
12
71 %
R2
5
2
R3
8
R
No. times Presented
as correct
No. times
Overgraded
% of times
Overgraded
No. of times
Undergraded
% of times
Undergraded
3%
9
30 %
R1 - 0
R2 - 0
R3 - 0
0%
0
0
1
R2 - 0
R3 - 1
6%
4
R0 - 4
24 %
40 %
0
R3 - 0
0%
3
R0 - 0
R1 - 3
60 %
6
75 %
0
0
2
R0 - 0
R1 - 1
R2 - 1
25 %
30
27
90 %
2
7%
1
3%
M0
22
20
91 %
2
9%
0
0
M1
8
7
88 %
0
0
1
M
M1 - 2
M0 - 1
12 %
Period September
R0
R1M0
R1M1
R2M0
R2M1
R3M0
R3M1
R0
0
0
0
0
0
0
0
R1M0
3
9
1
0
0
1
0
R1M1
1
0
2
0
0
0
0
R2M0
0
1
0
2
0
0
0
R2M1
0
0
2
0
0
0
0
R3M0
0
1
0
0
0
3
1
R3M1
0
0
0
0
1
0
2
EQA Grade
SLB & SLEs in DDESP
Barriers to Implementation: target April 2011
Pilot group of 7 optometrists to ‘train’ &
become accredited SLE at PHT JRC
Second group of 3-5 optometrists in Autumn
2010