Browsing by Author "Bursell, Sven-Erik"
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- ItemA modeled economic analysis of a digital tele-ophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy.(2006-01-24) Whited, John D; Datta, Santanu K; Aiello, Lloyd M; Aiello, Lloyd P; Cavallerano, Jerry D; Conlin, Paul R; Horton, Mark B; Vigersky, Robert A; Poropatich, Ronald K; Challa, Pratap; Darkins, Adam W; Bursell, Sven-ErikThe objective of this study was to compare using a 12 month time frame the cost effectiveness of a non mydriatic digital tele ophthalmology system Joslin Vision Network versus traditional clinic based ophthalmoscopy examinations with pupil dilation to detect proliferative diabetic retinopathy and its consequences Decision analysis techniques including Monte Carlo simulation were used to model the use of the Joslin Vision Network versus conventional clinic based ophthalmoscopy among the entire diabetic populations served by the Indian Health Service the Department of Veterans Affairs and the active duty Department of Defense The economic perspective analyzed was that of each federal agency Data sources for costs and outcomes included the published literature epidemiologic data administrative data market prices and expert opinion Outcome measures included the number of true positive cases of proliferative diabetic retinopathy detected the number of patients treated with panretinal laser photocoagulation and the number of cases of severe vision loss averted In the base case analyses the Joslin Vision Network was the dominant strategy in all but two of the nine modeled scenarios meaning that it was both less costly and more effective In the active duty Department of Defense population the Joslin Vision Network would be more effective but cost an extra 1 618 dollars per additional patient treated with panretinal laser photo coagulation and an additional 13 748 dollars per severe vision loss event averted Based on our economic model the Joslin Vision Network has the potential to be more effective than clinic based ophthalmoscopy for detecting proliferative diabetic retinopathy and averting cases of severe vision loss and may do so at lower cost
- ItemNonmydriatic teleretinal imaging improves adherence to annual eye examinations in patients with diabetes.(2007-02-20) Conlin, Paul R; Fisch, Barry M; Cavallerano, Anthony A; Cavallerano, Jerry D; Bursell, Sven-Erik; Aiello, Lloyd MWe studied whether nonmydriatic digital retinal imaging with remote interpretation teleretinal imaging in the ambulatory care setting affected adherence to annual dilated eye examinations among patients with diabetes We randomly assigned 448 patients to a teleretinal imaging group or a control group We measured the number of patients who had dilated eye examinations within 12 months of group assignment and the agreement for level of diabetic retinopathy between teleretinal imaging and the eye examinations The teleretinal imaging group n 223 had significantly more dilated eye examinations than the control group n 225 Teleretinal imaging and eye examination results showed significant correlation and moderate agreement Cataract and smaller pupil size were significantly associated with ungradable retinal images Two thirds of patients with ungradable images had other ocular findings Patients reported high satisfaction with nonmydriatic teleretinal imaging Nonmydriatic teleretinal imaging improves diabetic retinopathy assessment rates
- ItemThe relationship of a diabetes telehealth eye care program to standard eye care and change in diabetes health outcomes.(2008-01-07) Fonda, Stephanie J; Bursell, Sven-Erik; Lewis, Drew G; Garren, Jeonifer; Hock, Kristen; Cavallerano, JerrySeveral studies suggest that telehealth eye care programs that combine retinal imaging education and some care management can improve patient adherence to annual comprehensive eye examinations and follow up treatments Little is known however about whether such programs relate to other more distal outcomes that affect diabetic eye disease such as blood glucose control This paper assesses the relationship of participation in a diabetes telehealth eye care program with standard face to face eye care as well as improvements in other diabetes related health outcomes We conducted a retrospective study using data from electronic medical records of Joslin Diabetes Center n 13 752 The data span 2 years baseline and follow up Subjects eye care groups were no eye care eye care outside of the clinic standard eye care at the clinic or participation in the Joslin Vision Network telehealth eye care program We analyzed the relationship of participation in the telehealth eye care program at baseline to follow up eye care groups and changes in hemoglobin A1c low density lipoprotein levels and systolic blood pressure The results show that participation in the telehealth eye care program was significantly correlated with whether subjects later obtained standard eye care improvement in hemoglobin A1c and improvement in low density lipoprotein Thus telehealth eye care programs that incorporate evaluation education and care planning are related to use of recommended eye care and improvements in certain diabetes related health outcomes Such programs can address the many aspects of care necessary to reduce risk of vision loss due to diabetic retinopathy and other diabetes related complications Future research might test hypotheses suggested by sociological and psychological theories regarding causation between participation in a telehealth eye care program and other diabetes care
- ItemTelehealth in Australia: an evolution in health care services.(2013-07-08) Bursell, Sven-Erik; Jenkins, Alicia J; Brazionis, Laima; Rowley, Kevin G; Brown, Alex D
- ItemTelemedicine and ocular health in diabetes mellitus.(2012-05-18) Bursell, Sven-Erik; Brazionis, Laima; Jenkins, AliciaTeleretinal teleophthalmological programs that use existing health information technology infrastructure solutions for people with diabetes increase access to and adherence to appropriate eye care Teleophthalmological studies indicate that the single act of patients viewing their own retinal images improves self management behaviour and clinical outcomes In some settings this can be done at lower cost and with improved visual outcomes compared with standard eye care Cost effective and sustainable teleretinal surveillance for detection of diabetic retinopathy requires a combination of an inexpensive portable device for taking low light level retinal images without the use of pharmacological dilation of the pupil and a computer assisted methodology for rapidly detecting and diagnosing diabetic retinopathy A more holistic telehealth care paradigm augmented with the use of health information technology medical devices mobile phone and mobile health applications and software applications to improve health care co ordination self care management and education can significantly impact a broad range of health outcomes including prevention of diabetes associated visual loss This approach will require a collaborative transformational patient centred health care program that integrates data from medical record systems with remote monitoring of data and a longitudinal health record This includes data associated with social media applications and personal mobile health technology and should support continuous interactions between the patient health care team and the patient s social environment Taken together this system will deliver contextually and temporally relevant decision support to patients to facilitate their well being and to reduce the risk of diabetic complications